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There is good evidence for the benefits of short-term cognitive stimulation therapy for dementia but little is known about possible long-term effects.
To evaluate the effectiveness of maintenance cognitive stimulation therapy (CST) for people with dementia in a single-blind, pragmatic randomised controlled trial including a substudy with participants taking acetylcholinesterase inhibitors (AChEIs).
The participants were 236 people with dementia from 9 care homes and 9 community services. Prior to randomisation all participants received the 7-week, 14-session CST programme. The intervention group received the weekly maintenance CST group programme for 24 weeks. The control group received usual care. Primary outcomes were cognition and quality of life (clinical trial registration: ISRCTN26286067).
For the intervention group at the 6-month primary end-point there were significant benefits for self-rated quality of life (Quality of Life in Alzheimer's Disease (QoL-AD) P = 0.03). At 3 months there were improvements for proxy-rated quality of life (QoL-AD P = 0.01, Dementia Quality of Life scale (DEMQOL) P = 0.03) and activities of daily living (P = 0.04). The intervention subgroup taking AChEIs showed cognitive benefits (on the Mini-Mental State Examination) at 3 (P = 0.03) and 6 months (P = 0.03).
Continuing CST improves quality of life; and improves cognition for those taking AChEIs.
A pilot study was undertaken to investigate whether there was evidence that professional staffs' perception of a patient's environment were significantly altered by certain variables.
Gender and, to a lesser extent, age were found to be variables that significantly affect the perception of a patient's personal environment.
Psychiatrists and other mental health professionals should be aware that there may be significant differences between the way individual professionals perceive the same visual environment. Psychiatry may benefit from future links with environmental psychology research.
In the new style NHS an annual report is essential for all services. Senior registrars have the necessary skills and are ideally placed to co-ordinate such an enterprise as part of their management training. The typical structure for such a report is described and suggestions are made on content and format. Pitfalls are outlined from the authors' experience.
Concern is increasingly being expressed about the lack of provision for mentally disordered offenders, who by default end up within the penal system. Gunn et al (1991) in a study of sentenced prisoners identified a significant number who were mentally disordered to be in need of psychiatric treatment. Among these, 0.4% were considered to be mentally handicapped. Recent reports have emphasised the importance of diverting these individuals from the criminal justice system (Woolf & Tumin, 1991; Home Office, 1990; British Medical Association, 1990). However, the majority of such offenders do not fulfil the criteria for admission to hospital under the Mental Health Act 1983. Most are not overtly mentally ill and do not require treatment in conditions of medium security such as exist in regional secure units. However, it is not clear what provision there should be for such individuals. Smith (1988) described an open forensic unit for mildly mentally handicapped offenders (the Leander Unit). She concluded that there was a need for a specialised service to cater for these patients, who were neither appropriately nor adequately provided for by the general psychiatric services, the mentally handicapped services, regional secure units or special hospitals. Unfortunately, in practice there are very few facilities for this group of patients.
Broadmoor Hospital is one of the three special hospitals covering England and Wales. It provides approximately 500 beds for mentally disordered patients who on account of their dangerous, violent or criminal propensities constitute a grave and immediate danger to the public, requiring treatment in conditions of special security (Section 4, National Health Service Act, 1977). It is generally recognised, however, that there are patients in special hospitals no longer requiring treatment in conditions of maximum security. These patients could probably be more appropriately cared for elsewhere if the facilities existed in general psychiatric hospitals or the community. However, special hospital consultants frequently encounter significant obstacles when attempting to transfer patients to local hospitals. Dell (1980) highlighted this problem, suggesting that 16% of special hospital patients were waiting to leave, following the agreement of the DHSS and the Home Office to their transfer. This delay appeared to be due to hospitals not wanting to accept patients who might prove to be difficult or dangerous. At the time of this current study (March 1990) these difficulties in transferring patients were particularly relevant as two of the special hospitals, Broadmoor and Ashworth (Park Lane and Moss Side) were full for male patients and therefore closed to male admissions, despite a continuing demand for beds.
Regional secure units are a relatively new facility for the treatment of mentally disordered offenders and difficult to manage patients. Their role is still evolving. Previous studies have described details of referrals and admissions to such secure units (Higgins, 1981; Gudjonsson & Mackeith, 1983; Offen & Taylor, 1985; Faulk & Taylor, 1986; Bullard & Bond, 1988). To date, however, no studies have examined changes of practice in RSUs over time. The purpose of the present study is to examine changes in the admission characteristics of patients admitted to the Butler Clinic, regional secure unit for Devon and Cornwall since it opened in 1983 to the present time.
Epileptic automatism is now believed to be a rare disorder, and only a very small number of cases have been described (Knox, 1968; Gunn and Fenton, 1971; and Gunn, 1978) in which aggressive behaviour has occurred during automatism. There are important legal issues involved if a serious crime is committed and insane automatism is given as the defence.
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