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Performing an effective literature search to obtain the best available evidence is the basis of any evidence-based discipline, in particular evidence-based medicine. However, with a vast and growing volume of published research available, searching the literature can be challenging. Even when journals are indexed in electronic databases, it can be difficult to identify all relevant studies without an effective search strategy. It is also important to search unpublished literature to reduce publication bias, which occurs from a tendency for authors and journals to preferentially publish statistically significant studies. This article is intended for clinicians and researchers who are approaching the field of evidence synthesis and would like to perform a literature search. It aims to provide advice on how to develop the search protocol and the strategy to identify the most relevant evidence for a given research or clinical question. It will also focus on how to search not only the published but also the unpublished literature using a number of online resources.
•Understand the purpose of conducting a literature search and its integral part of the literature review process
•Become aware of the range of sources that are available, including electronic databases of published data and trial registries to identify unpublished data
•Understand how to develop a search strategy and apply appropriate search terms to interrogate electronic databases or trial registries
The assessment and management of violent behaviour in mentally disordered patients are no longer the sole domain of forensic psychiatrists, but are increasingly part of the day-to-day work of all psychiatrists and mental health professionals. Violence risk assessment has become a huge industry, and although the importance of dynamic, as well as actuarial, risk factors is now recognised, a more systematic approach exploring the psychodynamics in the aetiology, assessment and treatment of violent behaviour is often lacking. In this article I revisit some of the key psychodynamic principles and concepts relevant to an understanding of violence, summarising the historical contributions of key psychoanalytic writers on violence and aggression, and exploring the ideas of more contemporary writers working in the field of forensic psychotherapy. A psychodynamic framework for working with violent patients is introduced, focusing on the setting and containment, specific therapeutic interventions and monitoring countertransference reactions.
•Understand historical and contemporary psychoanalytic theories of the aetiology of aggression and violence
•Utilise a psychodynamic framework for working with violent patients and offenders
•Understand the use of countertransference in the risk assessment and treatment of violence
This article starts with a brief review of the UK Supreme Court's decision in the Montgomery case. Although much of the focus in discussing the case has been on the disclosure of risk, an important aspect of the model of consent contained in the judgment is that of dialogue. The model of informed consent set out in Montgomery suggests shared decision-making as the norm. Central to shared decision-making, however, is an awareness of values and of how values can vary between people. We introduce values-based practice as an approach that is entirely in keeping with the precepts of the Montgomery judgment. We go on to review how values-based practice and shared decision-making are relevant to psychiatric practice, using as examples recovery practice and compulsory detention under the Mental Health Act 1983.
•Appreciate that a new test of consent has been established as of a result of the UK Supreme Court's Montgomery ruling
•Learn about the role of values-based practice as a partner to evidence-based practice in implementing Montgomery
•Understand how values-based practice and Montgomery together support shared decision-making in psychiatry
Although cognitive therapy is a promising treatment for depression, high drop-out rates and, conversely, the specific elements that make the intervention effective continue to puzzle practising clinicians. This article discusses both therapist-related factors (including competence and competencies) and patient-related factors (such as engagement in therapy and external logistical problems with attendance) that are related to drop-out and suggests practical ways to address them and improve outcomes. It examines cognitive and behavioural elements of manualised cognitive therapy and discusses findings relating to cognitive–behavioural therapy (CBT) in particular.
•Understand factors associated with high drop-out rates in the cognitive therapy of depression and ways to reduce them
•Learn about treatment integrity in cognitive therapy of depression and its relationship to the clinical outcome
•Identify specific cognitive therapy techniques associated with patients' improvement in depression
When those whom the law terms ‘secondary victims’ – i.e. the passive and unwilling witnesses of injury, or of the threat of it, to others – seek compensation through the courts for the psychiatric injuries that they have suffered (traditionally but confusingly referred to as ‘nervous shock’ claims), there would in theory be the potential for a virtually limitless number of claims. For this reason, the courts have developed and apply a number of, to a large extent, arbitrary ‘control mechanisms’ as floodgates. This article describes these control mechanisms and other relevant law using recent illustrative cases and with particular reference to the assistance that the courts can expect of psychiatrists as to diagnosis and causation.
•Understand the law relating to the compensation of secondary victims for psychiatric injury
•Appreciate the arbitrariness of the application of the law, as demonstrated in particular by recent cases of such claims by secondary victims
•Understand the proper role of (and limits of) expert psychiatric evidence in secondary victim cases, and therefore how best to assist the courts in relation to them
This article is based on our experience of volunteering for the charity Festival Medical Services, to provide mental healthcare at the Glastonbury Festival of Contemporary Performing Arts and the Reading Festival. It describes the history of these annual events and the development of medical and psychiatric services offered. Principles of assessment and management of mental disorder in festival settings are outlined and common psychiatric presentations are described. Legal aspects of care are discussed. The article is intended primarily to inform others of this interesting and unusual form of mental healthcare and we hope that aspects of our experience will prompt reflection on psychiatric practice in other settings.
•Understand how psychiatric care is provided at the Glastonbury and Reading Festivals
•Recognise the symptoms and signs of organic and functional conditions likely to present to psychiatrists at festivals
•Identify the principles of psychiatric management in festival settings
DECLARATION OF INTEREST
I.R. and R.B. gain free entry to the Glastonbury and Reading Festivals through their voluntary work with Festival Medical Services.
Obesity and depression are conditions that have been linked through a great number of interesting mechanisms. To fully understand the implications of treatment choices it is necessary to continue to investigate the physiology of these two conditions. By examining the background of these problems and considering factors such as stress response, neurological change and systemic inflammation, we propose a cycle linking depression and obesity. With reference to this cycle, we discuss management options, focusing particularly on prescribing choices and current guidelines. An assessment of the medication options is provided demonstrating that prescribing choices can have a significant impact on ongoing physical health. The aim of this discussion is to raise awareness of current research and progress and to see whether the cycle of depression and obesity can be broken.
•Update knowledge of the mechanisms linking depression and obesity
•Understand the impact of medication on the cycle linking the two
•Consider how we can improve outcomes for patients with depression and/or obesity
The widespread nature of child sexual abuse is increasingly recognised and in the public domain following high-profile cases. Children and vulnerable people need protecting from such abuse. At the heart of the dilemma facing clinicians is the need to feel supported by the legislative framework to maintain confidentiality and use their clinical discretion in the best interests of their patients, ensuring that they receive the help they need, but also protecting others at risk. There are compelling arguments both for and against strengthening legislation to improve child protection.
•To understand the context for the potential introduction of mandatory reporting.
•To understand the arguments for and against mandatory reporting of childhood, including historic, sexual abuse.
•To reflect on the implications of mandatory reporting of childhood, including historic, sexual abuse for readers clinical practice.