Psychiatry recruitment continues to be a problem in the UK and large-scale studies are required to understand the factors surrounding this. A quantitative, cross-sectional online survey, incorporating demographics, career choices, teaching exposure, attitudes to psychiatry and personality factors, was administered to final-year UK medical students. A total of 484 students from 18 medical schools responded (66% women). Sixteen (16%) had chosen psychiatry at medical school entry. By final year, 15 respondents (3%) had decided to pursue a career in psychiatry, while another 78 (17%) were seriously considering it. There was little difference in the quality ratings of lectures and small group teaching between those interested in psychiatry and those not. Experience of 'enrichment activities' (psychiatry special study modules or components, psychiatric research, university psychiatry clubs, and psychiatry electives) were significantly more likely to take up psychiatry. Causality cannot, however, be determined in this study. The study identified several distinct groups of UK students: those deciding on psychiatry before medical school and maintaining that career choice, those deciding on psychiatry during medical school, and those interested in other fields. Addressing psychiatry teaching and exposure may improve recruitment into the speciality.
Patients with learning disabilities are not always involved in decision-making about their medications. This may mean that some patients are unfairly denied of their autonomy. We carried out an audit of current practice concerning consent to treatment in patients with learning disabilities against best practice guidelines. Data were collected via a questionnaire given to a sample of 70 patients with learning disabilities within the Salford catchment area. This questionnaire assessed whether patients were involved in decision-making regarding their medications and whether they were being given enough information to give informed consent. A total of 45 patients completed questionnaires. Overall, the patients' knowledge of their medications was poor, particularly of the proposed duration, possible disadvantages and name of the treatment. It appears that doctors are engaging these patients during consultations and discussing their medications. However, the delivery of this information needs to be improved, and patients' understanding and recall need to be checked more thoroughly.
Hannah Griffiths is based at Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK. N. Ha!der is based at Alpha Hosp!ta!, Bury, UK, and Manchester University, Manchester UK. N. Chaudhry is based at Manchester University, Manchester, UK, and Greater Manchester West Mental Health NHS Foundation Trust, Saltord, UK. Abstract Purpose -Great controversy surrounds the prescribing of antipsychotics for people with an intellectual disability This stems from a lack of research to support their use in this specific population together with their "off label" use to treat behaviour problems. This paper aims to review prescribing practice of antipsychotics by the Salford Intellectual Disability Psychiatry Department in accordance with standards adapted from nationally recognised guidelines. Design/methodology/approach -Data was collected from all 178 patients under this department including patient demographics, severity of intellectual disability, co-morbid diagnoses and details of any antipsychotic drug use. Main standards of prescribing measured: indication of antipsychotic prescribing; documented review of medications: documentation of side effects: documentation of physical health parameters including weight, blood pressure, blood glucose, lipids. Findings -In total, 126 (72 per cent) were prescribed antipsychotics. 42 (33 per cent of these were for challenging behaviour 91 (72 per cent) had indication documented. 123 (98 per cent) of prescriptions had been reviewed. There was not very regular documentation of side effects and physical parameters for monitoring metabolic syndrome. Practical impilcations -Data was taken from all patients under the care of Salford Intellectual DisabilityPsychiatric team therefore eliminating sampling bias. The audit findings will be of value to other UK urban psychiatry departments as they should be highly representative of a wider population of patients. The authors are already aware of lack of evidence in use of antipsychotic medication for treating challenging behaviours in patients with learning disability.Originaiity/value -This study confirms the use of antipsychotics in management of challenging behaviours in this population as a third of the sample population was being treated with antipsychotics for behaviour problems. The study also shows that there was lack of documentation of physical health and side effect monitoring. It highlights that there should be regular monitoring of physical and side effects with careful documentation.
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