In 2004 the Royal College of Psychiatrists made it clear that it was committed to increasing the involvement of service users and carers throughout psychiatric education. This has been mandatory since June 2005 and it has been a compulsory aspect of psychiatric training for schemes to demonstrate a meaningful involvement of users and carers in the training of psychiatrists.
We report a case of a 64-year-old lady who developed clinical features of Wernicke-Korsakoff syndrome following a laparotomy for small bowel obstruction. Following the operation she developed paralytic ileus and required total parenteral nutrition for one month. A suspected history of average 40 units of weekly alcohol consumption prior to the operation could not be confirmed and the patient did not show any sign of alcohol dependence. Within a few months of treatment with a daily oral dose of thiamine 200 mgs supplemented by multivitamins the patient showed subjective evidence of improvement in confusion, confabulation, and anterograde amnesia, although objective tests showed residual deficits in many areas of cognitive functioning, including immediate and delayed recall of verbal and non-verbal materials, planning and switching of attention.
The aim was to explore what happened during a five-year period to a group of patients with no previous psychiatric admissions, who were detained for the first time in a psychiatric hospital under part II of the Mental Health Act 1983. Subjects (n=189) who were detained under Section 2 or 3 in 1996 and 1997 in Queen Elizabeth Psychiatric Hospital, Birmingham were identified from computerised inpatient admission records. The mean age was 40.0 years (range 21-65). Nearly half of the cohort had a diagnosis of psychoses. Asians had the highest proportion of psychoses (64%) compared to African-Caribbean patients (48%) and White patients (41%). Almost half of the sample had a further admission, with Asian and African-Caribbean patients more likely to be readmitted than their white counterparts. Nearly a third of the cohort had a further compulsory detention. On re-admission, African-Caribbean subjects were more likely to be detained compared to Asian and White subjects. Fifty per cent had a further compulsory admission within a year of the index admission. The high number of psychoses in the Asian group may be due to their psychosis being more serious at presentation as a result of denial of illness and an increased co-morbidity with drug use in Asian men.
Aims and MethodThe aim of this study was to seek the views of consultant psychiatrists on the legal framework they would use when considering treatment with electroconvulsive therapy (ECT). A questionnaire, consisting of three clinical vignettes, was sent to 70 consultants in the Wessex rotation (East Dorset/Hampshire region).ResultsA total of 56 questionnaires were returned; a response rate of 80%. Most consultant psychiatrists agree when giving ECT to capacitated and non-consenting patients. However, there was a lack of consensus when dealing with seemingly incapacitated but compliant patients.Clinical ImplicationsMore clarification in this area is needed. Trusts can assist clinicians by devising their own policies based on nationally agreed standards of best practice. The treatment of mentally incapacitated but compliant patients is an area of practice where uncertainty exists. If proceeding under common law in such cases, it is good practice to discuss with relatives/carers and obtain a second opinion from a consultant colleague. The most recent Bournewood judgement and the new Mental Health Bill will have further implications for clinical practice.
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