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The complex relation between a person and their mental disorder is a recurring theme in (reflections on) psychiatric practice. As there is no uncontested concept of ‘self’, nor of ‘mental disorder’, the ‘self-illness’ relation is riddled with ambiguity. In this feature article, we summarise recent philosophical work on the phenomenon of ‘self-illness ambiguity’, to provide conceptual tools for psychiatric reflections on the self-illness relation. Specifically, we argue that the concept of self-illness ambiguity may contribute to patients’ self-understanding and shed light on how paradigms of care and research should be revised in order to help clinicians support that self-understanding. We also suggest that the concept of self-illness ambiguity may improve the understanding of particular mental disorders, and may offer conceptual tools to address various ethical matters (including stigma and responsibility).
This article explores the cultivation of medical knowledge via popular health guides among the Finnish lay populace from the 1890s to the 1970s. By using written reminiscences and newspaper articles as source material, the article discusses the relevance, popularity, and practical use of various printed health guides and manuals throughout Finland. We place particular focus on the late nineteenth to the early twentieth century as the period that experienced a high increase in lay education and literacy. By focusing on individual readers and their experiences of popular health guides, the article examines lay medical and health practices as the number of medical manuals dramatically increased from the late nineteenth century onwards. It also investigates the reception of medical, popular and irregular health movements, such as hygienism, nature cure, and Couéist autosuggestion, and the change in medical culture brought about by the appearance of patent medicines. As the information discovered in popular health guides tended to fluctuate between official and irregular medical theory, we analyse the relationship between learned, alternative, and vernacular medicine through the views and opinions expressed by people who engaged with health literature. Through these materials, we provide a novel understanding of the accessibility of medical knowledge, the spread and impact of health guides, and attitudes towards different medical practices among the Finnish reading public.
Fully updated for the second edition, this text remains a comprehensive and current treatment of the cognitive neuroscience of memory. Featuring a new chapter on group differences in long-term memory, areas covered also include cognitive neuroscience methods, human brain mechanisms underlying long-term memory success, long-term memory failure, implicit memory, working memory, memory and disease, memory in animals, and recent developments in the field. Both spatial and temporal aspects of brain processing during different types of memory are emphasized. Each chapter includes numerous pedagogical tools, including learning objectives, background information, further reading, review questions, and figures. Slotnick also explores current debates in the field and critiques of popular views, portraying the scientific process as a constantly changing, iterative, and collaborative endeavor.
Anne was one of a handful of women in neurology who were truly ‘academic’ – doing NIH-supported research, teaching students and residents, and seeing and treating neurological patients. In 1990, Anne received a letter from the Massachusetts General Hospital asking if she would be willing to be a candidate for chair of the Department of Neurology at the hospital and Julieanne Dorn Professor of Neurology at Harvard Medical School. Since she was happy in Michigan, she usually declined these letters, but this one piqued Anne’s interest. Massachusetts General Hospital was supposed to be the pinnacle of traditional, male-dominated medicine. Anne was eventually offered the position. She had to consider her family and if she really wanted to commit. Anne put together a five-year plan and had Nancy, Jack and Herb look at it before she sent it to Mass General. She spoke to Milton Wexler for advice on how to make the decision. Anne decided to take the job. Jack would be appointed professor of neurology and Zane instructor at Harvard Medical School. When she told Sid, he was sad to lose them but also proud that two of his ‘children’ were moving up to such a prestigious department. When she broke the news to her children that they would be moving across the country, Jessie showed enthusiasm and Ellen showed dismay.
This chapter analyses the international science collaboration between scientists in Chulalongkorn University (CU) in Bangkok and scientists and managers from Kawasaki Heavy Industry (KHI), Japan. The Chapter argues, first, that the integrity of national regulations is violated through international science collaborations, including by the governments whose regulations are violated. As there is no credible regulatory mandate on a global level, such violations receive little attention. Second, in contrast with notions of science collaboration that view collaboration as a bond between two or more partners to attain a shared goal by pooling resources, the chapter’s examination of the collaborative project shows that its goals are shared in different, often incompatible ways. And, third, observing how regulation in international science collaboration is treated as a form of ‘regulatory capital’, the chapter argues that international collaboration and competition form part of the same process. This study of regulatory capital explains why the examination of science collaborations does not just pertain to exchanges of scientific know-how and technological expertise; it also requires the investigation of the ways in which socio-economic, political and regulatory conditions enable available resources to be used to satisfy a range of goals, many of which are mutually incompatible.
Final Chapter 9 explains why ‘free’ market competition under regulatory capitalism underlies widespread unrecognized regulatory violence and argues that the cultivation of competitive desire (cf. Girard 2000) succeeds at the expense of what have become ‘sacrificeable’ patients. After a discussion of suggestions of altering the social contract between science and publics, and the observation of the prevalence of competitive desire in the context of political debate in the UK, I explain how, instead of regulatory capitalism based on competitive desire, a vision of caring solidarity applying the generative principle of creative desire (Adams 2000) would be more conducive to policies aimed at medical and public-health targets. I argue that guidelines rooted in ‘caring solidarity’ can largely prevent the violence of regulatory competition that has become endemic to regulatory capitalism. By avoiding high-risk strategies that are oriented on one-size-fit-all solutions expected to generate high-profit margins, the proposed vision of caring solidarity is more conducive to sustainable health. The rudiments of such a model, I suggest, would use the generative principle of creative desire, building on local notions of wisdom incorporating virtue ethics of prudence and justice.
Early pregnancy loss is a common but distressing occurrence. Caring thoughtfully for women and others experiencing pregnancy loss and being able to listen to and understand their concerns can make a real and positive difference. Communication is key: communicating with patients clearly and thoughtfully, and delivering unexpected or bad news sensitively is hugely important. Health professionals may need to talk with and support patients and partners as they make difficult decisions within a short period of time, so should feel confident in talking about procedures including the benefits and risks of treatment. Equally, it is important for health professionals dealing with difficult situations to know how and where to find support for themselves, and to be aware of the resources the Miscarriage Association provides to both patients and professionals.
National policy in England recommends that young people be admitted to mental health wards that are age-appropriate. Despite this, young people continue to be admitted to adult wards.
Aims
To explore the impact of young people’s admissions to adult wards, from the perspectives of young people, parents/carers and mental health professionals working in adult services.
Method
Semi-structured interviews were conducted with 29 participants to explore experiences of receiving and delivering care in adult mental health wards. Participants were four young people (aged 16–17 years), four parents/carers and 21 mental health professionals from adult mental health services in England. Data were analysed using framework analysis.
Results
Young people’s admissions to adult wards tend to occur out of hours, at a time of crisis and when no suitable adolescent bed is available. Admissions were conceptualised as a short-term safety measure rather than for any therapeutic input. Concerns were raised about safeguarding, limited treatment options and a lack of education provision for young people on adult wards. However, exceptionally, for older adolescents, an adult ward might be clinically or socially appropriate. Recommendations to reduce adult ward admissions included better integration of adolescent and adult services, having more flexible policies and increasing community provision.
Conclusions
Our findings emphasise the importance of young people being admitted to age-appropriate in-patient facilities. Earlier intervention and increased provision of specialist care in the community could prevent young people’s admissions to adult wards.
Knowledge on efficient approaches to the provision of post-disaster psychosocial care is urgently needed. To prevent unmet healthcare needs, proactive follow-up by municipal contact persons was recommended for survivors of the Utøya youth camp attack in Norway.
Aims
To examine characteristics of the survivors by whether or not they had a contact person in the early (0–5 months), intermediary (5–15 months) and long-term (20–32 months) aftermath of the attack, and to describe the survivors’ experiences with the contact person.
Method
We analysed data from three waves of interviews with survivors conducted 4–5, 14–15 and 30–32 months after the attack, as well as register-based data on the use of mental health services from 3 years before until 3 years after the attack.
Results
Survivors with a contact person early post-attack were less likely to receive care from mental health services concurrently or to have anxiety/depression symptoms subsequently compared with survivors without a contact person in the same period. Survivors with a contact person in the intermediary aftermath were more satisfied with the overall help they received, but also more likely to have long-term anxiety/depression symptoms. Survivors with a contact person in the long term were more likely to be financially disadvantaged. Approximately half of the survivors with a contact person found this highly or very highly useful, whereas one-third found it of little use or not at all useful.
Conclusions
The proactive outreach reached survivors across sociodemographic characteristics during the recommended first year of follow-up, which could be conducive to prevention of unmet healthcare needs. Still, there was considerable variation in the perceived usefulness and duration of the follow-up.
‘Complex emotional needs’ has emerged in the UK as a label to refer to individuals given a diagnosis of a personality disorder. We argue that this name change is insufficient to address the harms associated with the personality disorder construct; rather, it risks broadening its scope, and thereby the construct’s harms.
Section 2.1 reviews the behavioral measures that allow for the interpretation of brain activation results. Section 2.2 discusses techniques with high spatial resolution, such as fMRI, which is the most popular method. Section 2.3 focuses on techniques with high temporal resolution, such as ERPs. ERPs measure voltages on the scalp that directly reflect the underlying brain activity. In Section 2.4, techniques with excellent spatial resolution and excellent temporal resolution are described, including combined fMRI and ERPs, as well as recording from patients with electrodes implanted in the brain for clinical reasons. Section 2.5 considers evidence from patients with brain lesions and cortical deactivation methods such as TMS. Both methods have limited spatial resolution and poor temporal resolution; however, they can assess whether a brain region is necessary for a given cognitive process. In Section 2.6, the spatial resolution and temporal resolution of the different techniques are compared.
Research suggests that those caring for a loved one with an eating disorder in the UK report unmet needs and highlight areas for improvement. More research is needed to understand these experiences on a wider, national scale.
Aims
To disseminate a national survey for adults who had experience caring for a loved one with an eating disorder in the UK, informed by the findings of a smaller scale, qualitative study with parents, siblings and partners in the UK.
Method
A cross-sectional web-based survey was disseminated to adults who had experience caring for a loved one with an eating disorder in the UK.
Results
A total of 360 participants completed the survey. Participants described experiences of care received in both children and young people's, and adult services. Those receiving care from children and young people's services generally reported more timely care, greater involvement in care and more confidence managing their loved one's symptoms post-discharge. In both settings, participants identified a number of areas for improvement, including more timely access to care, improved transition processes and discharge planning, and increased involvement in their loved one's care.
Conclusions
This survey captures the experiences of individuals caring for a loved one with an eating disorder in the UK. There are identified discrepancies between experiences of care in children and young people services compared with adult services. Clinical implications and recommendations for improvement are discussed, including improved transition and discharge processes, increased involvement of and/or support for carers themselves, and more timely access to support services for the unwell individual.
Patient involvement in psychiatry education struggles to be representative of the patients that doctors will treat once qualified. The issues of mental health stigma, cultural perspectives of mental health and the unique role of teaching, required exploring to establish the barriers and facilitators to increasing the diversity of patients involved in psychiatry education. To explore the causes of this lack of representation, a roundtable event with 34 delegates composed of people with lived experience of mental health issues, people from underserved communities, academics, mental health professionals and charity representatives met to discuss the barriers to involvement in psychiatry education and possible solutions. Themes were further developed in a context expert focus group. Notes from the roundtable and focus group were analysed and developed into recommendations for medical schools and mental health professional teaching departments.
Child and adolescent mental health service in-patient beds are unevenly spread throughout England. Where demand outstrips bed availability, young people may be admitted at-distance or to adult psychiatric wards. The COVID-19 pandemic added pressures to already overstretched services. Understanding experiences during this period is vital to inform strategies for future emergencies.
Aims
To investigate the impact of the COVID-19 pandemic on admissions to local, at-distance or adult psychiatric units, from the perspectives of young people, parents/carers and healthcare professionals.
Method
Multi-methods data were collected from February 2021 to September 2022, as part of the Far Away from Home research programme. A 13-month national surveillance study collected information about admissions to general adolescent units >50 miles from home, out-of-region or to adult psychiatric units. Free-text data from respondents (n = 51) were analysed using content analysis. Interviews with young people (n = 30), parents/carers (n = 21) and healthcare professionals (n = 68) were analysed using thematic analysis.
Results
Restrictions during the COVID-19 pandemic affected young people's contact with others; the requirement to self-isolate on admission and following overnight leave felt distressing, and visiting was limited. This disincentivised overnight leave, leading to some discharges being delayed and others feeling rushed and high risk. The COVID-19 pandemic also accelerated the introduction of virtual meetings, enabling community teams and families to be more involved in therapies, meetings and decision-making.
Conclusions
Restrictions imposed during the COVID-19 pandemic were often negatively perceived. However, the increased use of technology was felt to be positive, widening inclusion and mitigating some negative effects of distance on admissions.
Over the past 50 years, mental health services have evolved significantly, influenced by shifts in theoretical and practical approaches to mental disorders. Key among these changes are the biopsychosocial and recovery models, which highlight resilience and quality of life in treatment. However, traditional psychiatry has often struggled to embrace these changes because of reductionist perspectives that overlook psychosocial factors, resulting in fragmented care and reduced accessibility. Proposed solutions have faced implementation barriers in absence of a coherent theoretical framework. Here, we outline how attachment theory may offer a promising framework to drive systemic change in mental health by emphasising secure emotional bonds at both the organisational and individual level. Within an attachment-informed culture, services may act as ‘organisational caregivers’ that promote continuity of care, independence and stronger clinical relationships. In turn, this may foster more inclusive, responsive and resilient mental healthcare systems that prioritise patients’ needs and empowerment.
The categorisation of personality pathology into discrete disorders has been an enduring standard. However, dimensional models of personality are becoming increasingly prominent, in part owing to their superior validity and clinical utility. We contend that dimensional models also offer a unique advantage in treating mental illness. Namely, psychotherapy approaches and the components of dimensional models of personality can both be arranged hierarchically, from general to specific factors, and aligning these hierarchies provides a sensible framework for planning and implementing treatment. This article begins with a brief review of dimensional models of personality and their supporting literature. We then outline a multidimensional framework for treatment and present an illustrative fictitious clinical case before ending with recommendations for future directions in the field.
The goal of Chapter 5 is to examine emoji use across the healthcare landscape, as well as what implications related to emoji theories can be gleaned from such usage and how emoji use can be applied to training healthcare professionals more generally. Prominently discussed in the chapter are clinical studies that indicate emoji writing (between practitioners and patients) may actually enhance medical outcomes. Also highlighted is the empirically attested fact that emoji scales and models may be good gauges for assessing well-being. The overall conclusion that can be drawn from the studies is that emoji might affect patients positively. Emoji are not medical cures in themselves, needless to say; they are simple pictures that affect patients positively, much like humor. They may also counteract the so-called nocebo effect, defined as a detrimental effect on health produced by psychological or psychosomatic factors such as negative expectations of treatment or prognosis.
Catatonia is a neuropsychiatric disorder characterised by psychomotor changes that can affect individuals across the lifespan. Although features of catatonia have been described in adults, the most common clinical symptoms among paediatric patients with catatonia are not well characterised.
Aims
The goal of this study was to characterise the symptoms of catatonia demonstrated by paediatric patients, and to explore demographic and diagnostic factors associated with greater catatonia severity.
Method
We conducted a multicentre retrospective cohort study, from 1 January 2018 to 6 January 2023, of patients aged 18 and younger with a clinical diagnosis of catatonia and symptom assessment using the Bush Francis Catatonia Rating Scale (BFCRS).
Results
A total of 143 patients met inclusion criteria. The median age was 15 (interquartile range: 13–16) years and 66 (46.2%) patients were female. Neurodevelopmental disabilities were present in 55 (38.5%) patients. Patients demonstrated a mean of 6.0 ± 2.1 signs of catatonia on the Bush Francis Catatonia Screening Item, with a mean BFCRS score of 15.0 ± 5.9. Among the 23 items of the BFCRS, six were present in >50% of patients (staring, mutism, immobility/stupor, withdrawal, posturing/catalepsy, rigidity), and four were present in <20% of cases (waxy flexibility, mitgehen, gegenhalten, grasp reflex). In an adjusted model, patients with neurodevelopmental disorders demonstrated greater BFCRS severity than those with other diagnoses.
Conclusions
Catatonia was diagnosed in a range of mental health conditions. Further research is needed to define optimal diagnostic criteria for catatonia in paediatric patients, and clarify the clinical course of the disorder.
Constipation is overrepresented in people with intellectual disabilities. Around 40% of people with intellectual disabilities who died prematurely were prescribed laxatives. A quarter of people with intellectual disabilities are said to be on laxatives. There are concerns that prescribing is not always effective and appropriate. There are currently no prescribing guidelines specific to this population.
Aims
To develop guidelines to support clinicians with their decision-making when prescribing laxatives to people with intellectual disabilities.
Method
A modified Delphi methodology, the RAND/UCLA Appropriateness Method, was used. Step 1 comprised development of a bespoke six-item, open-ended questionnaire from background literature and its external validation. Relevant stakeholders, including a range of clinical experts and experts by experience covering the full range of intellectual disability and constipation, were invited to participate in an expert panel. Panel members completed the questionnaire. Responses were divided into ‘negative consensus’ and ‘positive consensus’. Members were then invited to two panel meetings, 2 weeks apart, held virtually over Microsoft Teams, to build consensus. The expert-by-experience group were included in a separate face-to-face meeting.
Results
A total of 20 people (ten professional experts and ten experts by experience, of whom seven had intellectual disability) took part. There were five main areas of discussion to reach a consensus i.e. importance of diagnosis, the role of prescribing, practicalities of medication administration, importance of reviewing and monitoring, and communication.
Conclusions
Laxative prescribing guidelines were developed by synthesising the knowledge of an expert panel including people with intellectual disabilities with the existing evidence base, to improve patient care.