futurePsych - Royal College of Psychiatrists

RC
PSYCH
08/11 The Student Associate Newsletter
future
Are psychiatrists
subject to more
VIOLENCE
than doctors
in other
Psych
Body Integrity
Identity
Disorder: A
legitimate
diagnosis?
specialities?
Puerperal Psychosis
what is
hysteria?
plus⋅ book reviews ⋅ electives ⋅ events ⋅ societies ⋅ blogspot
SUMMER 2011
We have pleasure in bringing you the summer
edition of futurePsych. In this edition we
focus on some of the more unusual, but no less
interesting psychiatric presentations.
We also have a report on the first Psychiatry
Society conference, held in Sheffield, which
was held in March and attracted 50 delegates.
As ever, if you would like to contribute,
comment or get involved please contact Roxanne
(roxanne.keynejad@gmail.com)
or
myself
(sacha01@doctors.org.uk).
Sacha Evans
Sacha Evans Foundation Doctor Representative, PTC
EDITORIAL
!
Roxanne Keynejad
King’s College London
Student Representative, PTC
Katherine Adlington
Sabreen Ali
Bhakti Gajjar
King’s College London
University of Sheffield
King’s College London
!
!
!
!
Lena Jawad
Kaanthan Jawahar
Tim Leung
Lizz McKiernan
Lucy Potter
FY2 Southend Hospital
King’s College London
University of Cambridge
University of Bristol
FY2 Holywell Hospital
CONTENTS
5
hysteria..........................4-5
Editorial: What is hysteria?
20
puerperal psychosis.......6-7
Attitudes of Women to
Prophylactic Psychotropic
Medication During Pregnancy
body integrity identity
disorder..........................8-9
A legitimate diagnosis?
elective report............10-11
9
PTSD and mental health in
Northern Uganda
event report.....................12
First Conference of University
Psychiatry Societies, University of
Sheffield
review........................13-14
Are psychiatrists subject to more
violence than doctors in other
specialities?
16
psychiatry society......15-16
A Year in the University of
Birmingham’s Psychiatry Society
book review...............16-17
‘Schizophrenia: Who Cares?’ by
Tim Salmon
13
future events...................18
MEDFEST, RCPsych Congress,
Summer School etc.
8
blogspot...........................18
on the cover............................
6
4
futurePsych 06/11
EDITORIAL What is hysteria?
Elizabeth McKiernan, Final Year Medical Student, Bristol University
!
symptoms. Freud, predictably,
considered this stress sexual in
origin, attributing the illness to
disturbances of normal childhood
sexual development.[3,4]
Contemporary belief supported
the view that ‘deviant’ sexual
practices caused physical illness.
Both masturbation and
abstinence were believed to
cause ‘hysterical’ symptoms such
as neurasthenia (fatigue, anxiety,
headache, neuralgia and
Over 2000
4
inconsistent and medically
depressed mood) and ‘hysterical’
years ago Hippocratic physicians
inexplicable symptoms (which
patients were treated with
suggested the burning of sweet
often appear to be neurological)
clitoridectomy or vulval massage
smelling perfumes at the vaginal
which are believed to be due to
into the 20th century.[5]
entrance in order to lure the
the conversion of psychological
wandering womb back to its
trauma into physical symptoms.
original position and so cure the
[2]
Parson’s sick role describes the
advantages of being recognised
by society as unwell, for
feminine madness, “hysterikos”.
Explanatory theories are in
[1] To chart the history of
plentiful supply; the most famous
normal social roles and
“hysterikos” or hysteria is to
is likely that of Charcot and
responsibilities”. The
chart the history of psychiatry
Freud who based their
behaviourist’s secondary gain
itself; from the Greeks, to Freud,
psychoanalytic theory on
theory, attributes somatoform
through the behaviourists to
‘hysterical’ patients such as Anna
disorders to a subconscious
modern neuropsychiatrists.
example, “exemption from
O who appeared in Breuer and
desire to enter the sick role in
Hysteria is now better known as
Freud‘s pioneering work ‘Studies
order to benefit from the
conversion disorder and can be
on Hysteria‘ in 1895. They
advantages inherent therein.[6]
found in the DSM-IV under
suggested that symptoms were
A third theory is the sociological
somatoform disorders. Patients
produced by the ‘conversion’ of
theory which asserts that in
present with unfeigned yet
emotional stresses into bodily
societies
where displays
of
been limited studies conversion disorder is believed to be seen more frequently in societies where displays of emotion
are discouraged and also in sections of society lacking in power, for example women.[2] This could explain the
‘hysterical woman’ commonly seen in historial literature and the perceived reduction in prevalence of hysteria in this
country as women have gained in status and power over the last 100 years.
Recent studies have turned away from discussions of psychological aetiology and have looked instead towards
discovering the neurological process whereby symptoms such as paralysis could be produced when no organic brain
futurePsych 06/11
emotion are discouraged or suppressed emotions may instead be experienced as physical illness. Although there have
disease or lesion is to be found. Research using fMRIs and PET scanners has produced evidence that conversion
disorder is associated with “impairment of cortical and subcortical functioning”.[7] Studies by Flor-Henri et al (1981),
Marshall et al (1997) and Vuilleumier et al (2001) have suggested that “hysterical conversion deficits are maintained
by a functional disorder of striato-thalamo-cortical circuits controlling sensorimotor function and voluntary
behaviour”[7] In other words there is evidence that in patients with conversion disorder voluntary commands are
inhibited; that these individuals have a functional brain disorder rather than an organic one. Whether psychological
stresses could cause these functional changes is currently unknown.
The history of hysteria is rich and varied and by following its path through history we can view the evolution of
psychiatry from its origins to the present day. But is hysteria a valid medical diagnosis in the 21st century? Although
the term hysteria (with its misogynistic connotations) has rightly fallen out of use, I would argue that this is a genuine
psychiatric entity deserving of further study. Further research on this topic would help us better understand the, often
profound, effects of psychiatric or psychological illness on the body and to further breakdown the perceived mindbody dichotomy. We can only speculate as to how ‘hysteria’ will be viewed and explained in 100 years time. Perhaps
we will be able to explain all its symptoms in terms of precise brain function and chemistry or perhaps it will finally
be considered to have disappeared all together.
REF EREN CES
[1] Helen King “Once upon a text: Hysteria from Hippocrates” (1993) from Hysteria beyond Freud. University of California Press. pp. 3–90.
ISBN 0520080645
[2] Colm Owens and Simon Dein “Conversion disorder: the modern hysteria.” Adv. Psychiatr. Treat. 2006 12: 152-157. Royal College of
Psychiatrists.
[3] Sigmund Freud and Joseph Breuer, Studies on Hysteria, First published 1955, This edition published by Pelican Books 1974
[4] Keneth Levin, Freud’s Early Psychology of the Neuroses – A Historical Perspective, 1978, University of Pittsburgh Press, Feffer and Simons,
Inc., London IBSN 0-8229-3366-7
[5] Rachel P. Maines (1999). The Technology of Orgasm: "Hysteria", the Vibrator, and Women's Sexual Satisfaction. Baltimore: The Johns Hopkins
University Press. ISBN 0-8018-6646-4
[6] Graham Scambler, Sociology as Applied to Medicine, 2003, Saunders (W.B.) Co Ltd, ISBN: 0702026654
[7] Edited by Peter Halligan, Chrisotpher Bass and John Marshall, Contemporary Approaches to the Study of Hysteria - Clinical and Theoretical
Perspectives ISBN: 0 19 263254
5
futurePsych 06/11
PUERPERAL PSYCHOSIS
Attitudes of Women to
Psychotropic Medication
During Pregnancy
Josie Phizacklea, 4th Year Medical Student, Cardiff University
Puerperal psychosis (PP), an acute postnatal
to base their decision. The only clear cut
form of psychosis, can prove a devastating
advice available is that Sodium Valproate is a
diagnosis due to its rapid onset and swiftly
drug to be avoided if at all possible, due to a
fluctuating nature at such a vulnerable time.
7-12% rate of foetal malformations,
Risk of suicide during these episodes has
particularly
been found to be as high as 5%, and risk of
comparison to 2% to 4% for the general
infanticide as high as 4%1, highlighting the
population.8 Lithium has an incidence of
need to give this condition due attention in
major malformations, such as
our future careers. The hope is that with the
anomaly, ranging from 4% to 12%.9 Whereas
current system, women who are exposed to
atypical mood stabilisers show uncertain
certain risk factors, are ideally targeted pre-
safety parameters due to inconclusive data.10
conception, or during pregnancy as a last
It has been reported that those who do decide
resort, with advice on the prophylactic
to discontinue their medication during
medication options available to them. They
pregnancy have a doubled risk of PP.11
must then evaluate at what level to expose
their unborn child to potentially teratogenic
medication or risk the occurrence of this kind
of episode.
The factors that may justify prophylactic
medication have been identified as having a
particularly strong relationship with PP. These
include a diagnosis on the bipolar spectrum,2
a previous postnatal episode,3 a 1st degree
family history of PP or bipolar4 and being a
primi-parous women.5 The relative risk of a
post natal psychotic episode has been
suggested to be as high as 60% for some
women exposed to multiple factors.4,6,7
In terms of mood stabilising options
available to women at this vulnerable time
there is currently a lack of evidence on which
6
neural
tube
defects,
in
Ebstein's
“only 23% had a
positive attitude at
initial consultation”
Our study looked retrospectively at the
attitudes recorded for 52 women, with
increased risk of PP, over a five year period
at a South Wales Perinatal Psychiatry clinic.
These women included a range of those
already involved in mental health services,
39 of which had a diagnosis on the bipolar
spectrum, and 3 who only had one previous
episode of puerperal psychosis in their
history. The remainder included 6 women
with a diagnosis of schizo-affective disorder
and 4 with a history of depressive psychosis.
futurePsych 06/11
We found that a low
proportion (23%) of these
women had a positive attitude
towards exposing taking
medication during pregnancy
at initial consultation.
However, a higher proportion
(55%) of those who actually
became pregnant made the
final decision to medicate
when it came to weighing up
the risks, suggesting many
women felt it was a necessary
precaution. Perhaps most
importantly 46% of the
patients came for their first
appointment too late during
p r e g n a n c y, w h i c h c o u l d
reliable evidence base
nature of each individual’s
suggest a need to further target
regarding the teratogenic and
concerns.
those women at risk before
developmental effects of each
they conceive, to allow enough
drug. The full study
time to fully optimise
highlighted the unpredictable
medication adjustments and
nature of such a judgment and
qualitative data quotes
prevent any avoidable
the need to remember that
highlighting individual
teratogenic effects.
each decision has to be made
concerns and themes
In order to truly provide
on a personal basis and reflect
patient autonomy, further work
the multifaceted but delicate
is required to develop a more
*For the full paper
including references and
please
email
josiephiz@hotmail.co.uk
REF EREN CES
For a full list, please contact author
1.Comtois, Schiff, & Grossman, 2008; Psychiatric risk factors associated with postpartum suicide attempt in Washington
State, 1992-2001, American Journal of Obstetrics & Gynecology, Volume 199, Issue 2 , Pages 120.e1-120.e5 (cited
in Engqvist I, Åhlin A. et al, 2011, Comprehensive Treatment of Women with Postpartum Psychosis across Health Care
Systems from Swedish Psychiatrists’ Perspectives, The Qualitative Report, Volume 16 Number 1 p66-83)
2.Terp IM , Mortensen PB, 1998, Postpartum psychoses. Clinical diagnoses and relative risk of admission after parturition.
Br J Psychiatry;172:521-526.
3.Heron J, Craddock N, Jones I. 2005, Postnatal Euphoria: are ‘the highs’ an indicator of bipolarity? Bipolar Disorders
7:103-110.
4.Jones I & Craddock N, 2005, Bipolar disorder and childbirth: the importance of recognising risk, Br J of Psychiatry, 186,
453-454
5.Robertson Blackmore E et al 2006, Obstectric factors associated with bipolar affective PP. Br J Psychiatry, 188, 32-6
7
futurePsych 06/11
BODY INTEGRITY IDENTITY
DISORDER
A legitimate diagnosis?
Roxanne Keynejad, Year Three, Graduate Entry MBBS, King’s College London
Body Integrity Identity Disorder
(BIID) is a new categorisation
proposed in 2000 for inclusion in
the forthcoming DSM (V). This
disorder is characterised by the
persistent and intense desire to
have an apparently functional
body part, usually an arm or a leg,
amputated. Its delineation focuses
on patients whose desire for
amputation centres around a need
to become, paradoxically, whole
by matching their body to their
internal body identity. This is in
contrast to those whose desire is
sexually
motivated:
Apotemnophilia1. One of the
disorder’s strongest advocates is
Dr Robert Smith, the infamous
Scottish surgeon who amputated
the healthy limbs of two patients
in NHS hospitals in 2000.
The proposed diagnostic criteria
for BIID use Gender Identity
Disorder as a template,
highlighting parallels with
patients who feel that their bodily
gender is at odds with their
internal gender. One criterion is
that “the diagnosis is not made if
the condition is better explained
by another medical or psychiatric
diagnosis”1.
One school of thought resists
separating BIID from
apotemnophilia, arguing that
patients who deny any sexual
element to their ‘identity
8
disorder’ still suffer from an
‘erotic fantasy’, of ‘undergoing
amputation of a limb, and
subsequently overachieving
despite a handicap’2.
A more psychoanalytic account
describes a factitious disability
disorder attributed to a lack of
parental care in childhood; the
disability may attract attention
and admiration of which the
adult was deprived in
childhood3.This approach
predicts that psychotherapy will
be the most effective treatment,
but this has not yet been
systematically investigated4. In
all such inpatients, the risk of
self-amputation must be
considered in discharge planning.
It is predicted that if BIID enters the
DSM (V), there will be a large
increase in diagnoses – as occurred
the introduction of Gender Identity
Disorder. It is therefore vital to
publish case studies of the
therapeutic outcomes of patients
desiring amputation of a healthy
limb, especially given the additional
importance of risk assessment on
discharge to a community setting.
While the diagnosis of BIID remains
controversial, consideration of other,
analogous disorders highlights areas
of inconsistency. Given the dramatic
surgical implications carried by
acceptance of BIID into the DSM
(V), a great deal more research is
first needed, to understand this
complex and fascinating
psychopathology.
futurePsych 06/11
DIFFERENTIAL DIAGNOSIS
Psychosis:
A desire for
amputation may centre on a
delusion about the limb that is
believed to be defective or
tainted.
Somatoparaphrenia:
A
neurological deficit caused by a
stroke can cause a patient to no
longer recognise his or her limb.
Limb sensation and use may be
impaired.
Apotemnophilia:
In the
context of admiration for
amputees, identification with
amputees or sexual fantasies
involving amputation or being an
amputee.
Body Dysmorphic
Disorder: The limb
Vitruvian man, Leonardo Da Vinci
REF EREN CES
may be
perceived as ‘deformed’, with
amputation desired to remove the
deformity, with a strong impact on
self-esteem.
Body Integrity Identity
Disorder: The patient will
fit the criterion of “a strong and
persistent disability
identification, which is the
desire to be, or the insistence
that one is, internally,
disabled”1, and will become whole
after amputation.
1. Furth, G.M., & Smith, R. (2000).
Amputee identity disorder: Information,
questions, answers, and
recommendations about self-demand
amputation. Authorhouse.
2. Bensler, J.M., & Paauw, D.S. (2003).
Apotemnophilia masquerading as
medical morbidity. Southern Medical
Journal 96 (7), pp. 674-6.
3. B r u n o , R . ( 1 9 9 7 ) . D e v o t e e s ,
pretenders and wannabes: Two cases
of factitious disability disorder. Journal
of Sexuality and Disability15, pp.
243-260.
4. F i r s t , M . B . ( 2 0 0 5 ) . D e s i r e f o r
amputation of a limb: Paraphilia,
psychosis, or a new type of identity
disorder. Psychological Medicine 35,
pp. 919-928.
9
futurePsych 06/11
ELECTIVE REPORT
PTSD and Mental Health in Gulu,
Northern Uganda December-January 2009
Dr Emily Sherley
I chose a psychiatry Elective because of my
interest in Uganda. There is a high rate of Post
Traumatic Stress Disorder among the Acholi people
in the north, following the 1986-2006 guerrilla war
between Uganda’s government and the rebel Lord’s
Resistance Army LRA).
The LRA is infamous for using child soldiers
and committing atrocities against civilians. Villages
were attacked, their inhabitants killed, beaten and
raped; crops and stores were stolen and roads made
impassable. In an attempt to gain control the
Ugandan government moved over 90% of the
population of the north into Internally Displaced
Persons camps; by 2005 these contained 2 million
people. Unable to farm, the Acholi became
dependent on the World Food Programme.
PTSD is triggered by events ‘of an
exceptionally threatening or catastrophic nature’,
especially violent crimes, sexual abuse, war and
torture. Sufferers experience flashbacks and
nightmares, as well as hypervigilance; they repress
memories or obsess about them. Ugandan victims I
spoke to – both former child soldiers and civilians exhibited these symptoms. Dreams about loved ones
being killed or abducted were common, often
ongoing for decades.
10
These experiences are exacerbated by
other conflict-related problems. Alcoholism is
rife, primarily among men, as a way to forget
their trauma. Subsequently, domestic violence is
extremely prevalent, causing a vicious cycle of
further PTSD triggers and symptoms in women.
Gulu town, once at the centre of the
conflict, is now at the heart of regeneration. I
worked with three organisations there:
- Gulu Regional Referral Hospital Mental
Health Unit, the main psychiatric centre in
the north, runs outreach and daily outpatient
clinics.
- The Peter C. Alderman Foundation, an
American NGO, specialises in rehabilitating
victims of trauma.
- The African Centre for Treatment and
Rehabilitation of Trauma Victims (ACTV)
spends up to four days at a time in the field
addressing all aspects of victims’ lives.
medical elective, all the teams involved me fully.
I found my psychiatry elective an excellent way
to develop the brief grounding I had as a student
– and by visiting a developing country I learned
a way of practising using limited resources. The
‘western’, NICE-guided way of treating patients
simply is not possible.
A place as traumatised as northern Uganda
will not heal overnight; but hope remains so
long as victims of trauma have someone to talk
to - even though, as one ACTV social worker
told me - “sometimes the best you can do is
listen to their stories and say ‘I’m sorry’.”
futurePsych 06/11
Psychiatry is very paternalistic in Uganda,
but PTSD management seems an exception, focusing
on talking therapies, involving the patient in
treatment. Medication is used in most cases,
antidepressants primarily (usually amitriptyline),
often with an antipsychotic (haloperidol). Almost
universally, patients I spoke to had seen a benefit
from therapy, especially meeting others who shared
their experiences. But the further away people are
from Gulu town, the harder it is for them to access
help.
Although there were fewer hands-on
opportunities for me than there may have been in a
REF EREN CES
1.Finnstrom, Sverker, Living With Bad Surroundings: War, History and Everyday Movements in
Northern Uganda, Duke University Press, Durham and London, 2008
2.NICE Guideline Post-traumatic stress disorder, The management of PTSD in adults and
children in primary and secondary care, The Royal College of Psychiatrists & The British
Psychological Society, 2005, available at http://www.nice.org.uk/nicemedia/live/
10966/29772/29772.pdf [accessed 21/05/10]
11
futurePsych 06/11
EVENT REPORT
First Conference of
University Psychiatry
Societies, University of
Sheffield
Ross Runciman and Rob Bartram, Sheffield Medical School
Sheffield PsychSoc organised the 2011
University Psychiatry Network Conference on
Saturday 19th March. Some 50 delegates and
speakers converged on Sheffield Medical
School to participate in this event. The
conference attracted medical students from as
far afield as Dundee and Southampton who
shared an interest in psychiatry. General talks
about training as a psychiatrist and specific
papers on diverse topics such as psychiatry and
the arts, as well as eating disorders, completed a
full programme for the day.
After a welcome and introduction from
Professor Woodruff, Professor Craddock began
a broad discussion about what it takes to be a
fully-trained psychiatrist. Drawing on personal
experience, Professor Craddock outlined the
importance of the psychiatrist being a wellrounded doctor. Continuing this theme later, Dr
Mitchell – Deputy Training Programme
Director for the South Yorkshire Deanery –
explored the nature of core training, ably
assisted by trainee doctors. An open floor
debate ensued in which speakers and delegates
were able to discuss the nature of core and
specialist training, the reality of this on a daily
basis and what selection panels are looking for
in potential trainees.
A complete change of pace was
provided by Dr Claridge, who explored how
ECGs are an important part of the diagnostic
toolkit of the psychiatrist, and Dr Moss, who
12
mapped the terrain of eating disorders in
children and adolescents.
Two controversies were addressed in
the conference: Dr Das posed the question of
whether creativity is necessarily allied to mental
instability, whilst Dr Ahluwalia asked whether
heroin should be prescribed on the NHS.
Dr Stringer engaged the audience with
an explanation of ‘extreme psychiatry’ – an
alternative model of teaching which engenders
a genuinely supportive learning environment
for students of psychiatry, currently offered to
medical students at Kings College London. For
more information about this interesting
development
please
visit
www.extremepsychiatry.wordpress.com
During three breaks in the day,
activities focused on the poster displays
attended by student authors with topics ranging
from previous psychiatry summer schools to
Post Traumatic Stress Disorder. The poster
sessions highlighted how undergraduates are
active in all areas of research.
Each presentation sparked lively
debate, demonstrating the enthusiasm of
delegates for psychiatry. The informal feedback
was encouraging with students stating that it
was a worthwhile day that needs annual
organisation. Hosts of the conference, Sheffield
PsychSoc, would like to thank speakers and
delegates for making the day a successful event.
Are psychiatrists subject to
more violence than doctors
in other specialties?
futurePsych 06/11
REVIEW
Sonia Sangha, FY2, Central Middlesex Hospital, April 2011
I recently attended ‘Psychiatry as a career: Everything you
wanted to know but were afraid to ask’ at the Royal Society
of Medicine. Some of the lectures not only allayed concerns
and myths about psychiatry, but challenged some of my own pre-conceived ideas. In particular,
the section, ‘Is psychiatry a risky profession?’ presented by Dr. Mark Salter and Dr. Victoria
Cohen, was undeniably controversial, with 70% of the audience agreeing that it was!
Dr. Salter compared two studies to debate the question he had set out for discussion.
The first (Wyatt and Watt) looked at 100 junior doctors working in Accident and Emergency
departments in the U.K. The study found that 18% of doctors, not including duty on-call
psychiatrists assessing patients in A+E, had been assaulted by patients on a total of 23
occasions and that 32% had said that patients had tried to assault them. None of those assaulted
received any counselling. Only 11% had received any training on how to manage aggressive
patients, although 88% had believed that it would be useful.
The second study (S. Davies) set out to determine the annual rates of assaults and threats to
psychiatrists. Over a year, 17% reported one or more assaults and 32% reported one or more
threats (see table 1). In this case, 48% had attended a course on dealing with aggressive
patients, which 87% had found useful.
Table 1: Frequency of assaults and threats reported by
respondents (n=139)
Davies S. (2001) Assaults and Threats on Psychiatrists. The
Psychiatrist, 25, 89-91
13
futurePsych 06/11
Dr. Salter concluded that the evidence
from these studies illustrated that
violence in the mental health
population is no greater than that in the
general population and the cause of it is
likely to be related to the same factors
in the two populations. Thus,
psychiatry is no more ‘risky’ a
profession than other specialities.
Further research presented, showed that
substance misuse and psychopathy are
often useful predictors of violence in the
mentally ill. Often substance abuse and
mental illness co-exist. These useful
predictors, along with supervision,
greater opportunity to attend appropriate
courses and supportive colleagues, place
psychiatrists in a ‘safer’ position.
In conclusion, mental illness and violence
are often considered intrinsically linked
by doctors and lay people alike, often due
to skewed media coverage. For example,
the misunderstanding of schizophrenia as
an illness, demonstrated in Alfred
H i t c h c o c k ’s f i l m ‘ P s y c h o ’ a n d
schizophrenic patients being portrayed as
violent.
This is being addressed currently by the campaign, ‘Time to Change,’ after a YouGov poll of 2,010 people
found that more than a third held the belief that all sufferers of schizophrenia are violent!
Overall, the meeting was a great success and it fulfilled my expectations. I left feeling that psychiatry is a
speciality that has a great deal of uncertainty and complexity about it, but then that is what makes it unique
and is the very reason why I am committed to pursuing psychiatry as a career.
REF EREN CES
Fottrell E. (1980) A study of violent behaviour among patients in psychiatric hospitals.
British Journal of Psychiatry, 136, 216-221.
Wyatt JP, Watt M. (1995) Violence towards Junior Doctors in Accident and Emergency
Departments. J Accid Emerg med, March; 2(1), 40-42.
Chubb H. (1997) Safety awareness among junior psychiatrists and provisions for their
safety in the workplace. Psychiatric Bulletin, 21, 80-83.
Shaw J. (2000) Assessing the risk of violence in patients. British Medical Journal, 320,
1088-1089.
Davies S. (2001) Assaults and Threats on Psychiatrists. The Psychiatrist, 25, 89-91
14
Society
As one of the University of Birmingham Medical
School’s newest societies, PsychSoc has had a busy
and successful 1st year....
The society was set up just over a year ago by two
of the then fourth year students. Inspired by their 6week clinical psychiatry rotations, they wanted to
raise the profile of Psychiatry as a speciality
amongst Birmingham medics. Specialities such as
surgery and paediatrics already had up-and-running
societies, and it was felt that Psychiatry deserved a
similar platform to inspire students and allow
individuals to explore and develop their interest in
mental health.
A new committee was appointed in spring 2010,
allowing larger-scale events to be organised, and
over the past year we have been able to conduct a
variety of events, bringing together a great
combination of education, entertainment and
charity fundraising.
The year kicked off with a fascinating talk on
Literature and Psychiatry delivered by poet and
consultant psychiatrist Femi Oyebode. This was
followed by several popular film nights held at the
Medical School. Featured films included Lolita and
Girl Interrupted, both acclaimed films with
interesting psychiatric themes. What followed was
a discussions of the issues raised.
Later on in the year, a talk by consultant
neuropsychiatrist Dr Rickards provided
insight into Gilles de la Tourette syndrome,
dispelling several common myths about the
condition. Things briefly quietened down
over the summer, but in September there was
a lot of interest from first year medical
students at the Freshers’ Fair event.
Attending PsychSoc events is a great way for
preclinical students to get a taste of
psychiatry before they do their clinical
attachment in the 4th year and also a way to
meet people and develop new interests.
futurePsych 06/11
PSYCHIATRY SOCIETY
A Year in the University of
Birmingham’s Psychiatry
We’ve also been busy fundraising for mental
health causes, with our most recent cake sale
raising almost £60. This was donated to
MIND, a national charity providing
information and support to promote good
mental health across England and Wales. The
stall was also used to publicise the Reading
for Wellbeing scheme. This began in
Liverpool, and is based on running reading
groups for patients in secure psychiatric
units. Consultant forensic psychiatrist Dr
Fearnley, winner of RCPsych’s psychiatrist
of the year 2009, came to speak to an
enthusiastic crowd of potential volunteers
and provided more information about the
scheme and the benefits of getting involved.
There was a great turnout, and we are hoping
to get a local student version of the scheme
up and running soon, which would
allow
direct student
involvement
w i t h
inpatient
r e a d i n g
groups at the
Barberry and
Oleaster
centres near
campus.
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There is also more to come over the next few
months, including an upcoming talk on
famous forensic psychiatric cases. We are
additionally planning a practice psychiatry
OSCE evening, aiming to help students
prepare for their 5th year psychiatry exam.
Opportunities for psychiatry career bite tasters
are imminent. These ‘tasters’ would allow
students to get first-hand experience of the
areas of psychiatry that they are interested in
during a short clinical placement. If anyone is
interested in finding out more or would like to
get more involved with the society, then we
would be delighted to hear from you. Please
email:
psychsoc@hotmail.com
Harriet Greenstone
Year medical student,
University of Birmingham
4th
BOOK REVIEW
Schizophrenia: Who
Cares?
Declan Hyland, Core Trainee 1, General Adult Psychiatry,
Mersey Care HNS Trust
“Schizophrenia: Who Cares?” is a thoughtprovoking and brutally honest personal account
of a father’s struggle through the development of
his son, Jeremy’s, paranoid schizophrenia. An
intelligent student at school, Jeremy starts to
struggle academically during his first year at
university. He decides to quit and embark on a
career in accountancy, but begins to struggle to
complete even simple work-related tasks. A
dubious diagnosis of “delayed adolescent crisis”
is all the GP can offer. Unconvinced, the author
consults a psychiatrist friend who proposes that
Jeremy’s social and cognitive decline point to a
prodromal phase of schizophrenia and
recommends formal assessment in the local
psychiatric unit.
Jeremy elopes to Edinburgh but is persuaded to undergo an informal admission to a different inpatient unit,
where he is detained under the Mental Health Act when he tries to self-discharge from the unit. Tim Salmon
describes his frustrations in trying to secure appropriate accommodation in the community for his son and
his annoyance that Jeremy’s inpatient admissions are lengthened by these delays.
The integral role of the Care Programme Approach (CPA) is also outlined, with its aim of providing “a
seamless network of care” for the patient to ensure that he does not “fall through the net” and into the
pattern of “revolving door syndrome”. Nonetheless, later on in the book, bureaucracy hinders Jeremy’s
application for Disability Living Allowance, Income Support and Housing Benefit – hardly in keeping with
the policy of providing “a seamless network of care” for those with mental illness.
16
The reader is left to reflect on the meaning of the charity, Rethink’s “ethos of recovery”. Salmon views
schizophrenia as being unique under the umbrella of “mental illness”, in that it tends to be a chronic,
lifelong diagnosis. Yet twenty-one years since Jeremy’s first psychotic episode, he is doing well. He lives
in his own flat, taking antipsychotic medication regularly, has a long-term girlfriend and his own group of
friends. Throughout the course of his mental illness, his father has been his pillar of strength, and no
doubt, will always be for the rest of his life.
futurePsych 06/11
The problems associated with staff transition are also highlighted – the frustration that after establishing a
therapeutic rapport with the Community Psychiatric Nurse, Social Worker or Consultant Psychiatrist, he
or she then moves to another post and so the process must start again. It is a compelling insight into the
experiences of carers, highlighting their needs, which must also be addressed.
I thoroughly enjoyed this book and found it very difficult to put down. It provided an invaluable insight
into the author’s personal experience of living with schizophrenia from the point of view of the main
carer. The author enlightens the reader on some of the flaws in mental health service provision; he is not
afraid to be controversial. I would strongly recommend this book to both users and providers of mental
health services, especially since it is so reasonably priced at only £12.00.
AB OUT TH E AUTH OR:
T I M S AL M O N
Tim Salmon is a writer, translator and photographer. He writes
about other countries, particularly France and Greece
and
has written guidebooks, cookery books and travel accounts.
He has written
for the Guardian, Independent, Times,
Observer, Telegraph and Sunday Times and magazines like
Time Out, Country Life, GreatOutdoors, The Countryman and
London Review of Books. http://timsalmon.org/.
LIBRARY AND INFORMATION SERVICE The home of information at the College
The College Library is dedicated to using its knowledge and know-how to provide you with precise
and reliable information.
Get in touch with the library team and ask us to conduct a literature search or find articles for you.
Visit us at the College, or contact us by telephone, fax or email:
•Telephone: 020 7235 2351 x 6138
•Fax: 020 7259 6303
•Email: infoservices@rcpsych.ac.uk
•www.rcpsych.ac.uk/library
Early for a College meeting? Why not come in and relax, read the daily newspapers or the latest
journals, check your emails, browse the library shelves and enjoy a cup of tea or coffee.
17
futurePsych 06/11
----------------------------------------EVENTS
-----------------------------------------
!!
Institute of Psychiatry Summer School, Monday 18 July – Friday 22 July 2011.
Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF
--------------------------------------------------------------------------------------------------------------------------Sheffield Psychiatry Summer School, Monday 1 August - Thursday 4 August 2011.
Four days of talks, networking sessions, field trips and visits to clinical facilities for undergraduates who are
interested in a career in psychiatry. Ample opportunities to meet with current trainees, consultants, students and
researchers. A social evening with dinner and drinks, and further opportunities for socialising and networking.
Visit http://psychiatrysummerschool.com/ for further details.
--------------------------------------------------------------------------------------------------------------------------National Forensic Trainees’ Conference, 8-9th September 2011, Brighton Grand Hotel.
Topics include Medico-legal Seminars, Violence & Murderous Personalities, and Lessons from Prisons.
Enquiries/Reservation: forensictraineeconference@gmail.com. Cost £140/£160 with dinner.
--------------------------------------------------------------------------------------------------------------------------Mental capital, mental disorders, resilience and well-being through the life-course.
Main conference: 9th - 11th March 2012, Trainee day: 12th March 2012.
* Poster competition on the trainee day, trainee delegate social event.
* Location: Queen Mary, University of London, East London
* Facebook: 'World Association of Cultural Psychiatry Congress 2012: Trainee Day'
* Twitter: @wacptrainee.com, E-mail: wacp2012trainees@gmail.com, Website: www.wacp2012.org/registration/
----------------------------------------BLOGSPOT
THE ART OF PSYCHIATRY:
http://www.artofpsychiatry.co.uk/
A website and society formed to explore the
shared
elements
between
the
arts
and
psychiatry.
POST SECRET:
http://www.postsecret.com/
A community art project where people from all
over the world represent their secrets
visually on postcards. It is always about
love, loss, addiction, anxiety and depression.
RC
PSYCH
ROYAL COLLEGE OF
PSYCHIATRISTS
RC
PSYCH
ROYAL COLLEGE OF
PSYCHIATRISTS
RC
PSYCH
ROYAL COLLEGE OF
PSYCHIATRISTS
18
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future
Psych
Royal College of Psychiatrists
17 Belgrave Square
London SW1X 8PG
Disclaimer: The opinions expressed in this newsletter are those of individual authors
and do not necessarily represent the views of the Royal College of Psychiatrists.
Tel: 020 7235 2351
Fax: 020 7245 1231