futurePsych - Royal College of Psychiatrists
Transcription
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 ([email protected]) or myself ([email protected]). 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 [email protected] 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. 15 futurePsych 06/11 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: [email protected] 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: [email protected] •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: [email protected]. 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: [email protected], 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 19 futurePsych 06/11 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