A representative sample of 41 cases of self-poisoning was studied in depth. In each case 'reasons' for taking the overdose, both stated spontaneously and chosen from a presented list, were recorded. The commonest spontaneous reason was the 'wish to die'. Nearly one-third indicated some non-suicidal purpose early in the interview and consistently denied suicidal intent subsequently. Apart from suicidal intent, reasons chosen from the list bore little resemblance to reasons that had been offered earlier in the interview and are therefore of uncertain relevance. Three psychiatric judges attributed reasons for each case based on common-sense criteria. Several reasons were seldom or never chosen by them; four were chosen frequently with good agreement, i.e. communicating hostility, influencing others, relieving a state of mind and suicidal intent. The first two were the most frequently chosen, attributed to 71 per cent and 54 per cent of cases respectively. They were the reasons chosen least frequently by the self-poisoners themselves. Of 23 (56 per cent) subjects indicating suicidal intent, 12 (29 per cent) were judged to be suicidal by psychiatrists. These were not clearly distinguishable on the basis of their original interviews, except that those judged suicidal tended to indicate suicidal intent early in the interviews. The clinical and research implications of these findings are discussed.
Recovery from mental illness is a fairly straightforward concept to members of the general public: “am I going to recover”, “what are the chances of recovery”, or “is our son/daughter ever likely to recover”? These are the sorts of questions that doctors and psychiatrists get asked every day.
Early intervention in psychosis is a strategy for which there is increasing theoretical and pragmatic justification. Many studies have been published describing the benefits of early intervention as carried out by specialised and innovative projects. The present paper describes how a generic community mental health team (CMHT), covering a population of 50 000, introduced strategies for early intervention with no extra funding. The team worked together to change old attitudes and practices. A style of intervention was developed to engage with and keep in contact with people with recent onset psychosis. This appears to be achievable – and this model may be an alternative to the setting up of specialised teams.
Some form of psychotherapy is now often attempted with psychiatric in-patients, even though most discussion of the subject is concerned with out-patients. This study looks at how a group of junior doctors used psychotherapy with 38 patients who were routinely admitted to an acute admission ward. Information was gathered from the doctors at the beginning of the treatment, during its course, and at the time the patient was discharged. Three distinct patterns emerged. One group of patients were seen as candidates for psychotherapy and definite progress seemed to be made. A second group were seen as candidates for psychotherapy but somehow no progress was made. A third group of patients were never seen as candidates for psychotherapy. These groups are looked at in some detail and the implications are discussed.
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