Psychiatry On-Line News

St John's Wort vs. Imipramine

The BMJ published the results of a German study in September 2000. The study showed that for mild to moderate depression. St John's Wort was as effective as imipraime and better tolerated. Given the variety of side effects with imipramine the latter point is perhaps unsurprising.

A new drug, galantamine or Reminyl has received its second European approval. It acts by boosting levels of acetylcholine by blocking the actions of acetylcholinesterase, but it also modulates nicotinic receptors. 

BBC commissioning new series

Kudos Productions have been commissioned by BBC Television to produce a landmark series about men and women with everyday confidence issues in their work, home and love lives - the worried well, not the clinically ill. We plan to take them to a country home for one week, where a team of three practitioners from different but complementary disciplines who will plan and conduct workshops/one to one sessions, giving practical lifeskills and tools that our participants and viewers can use in their lives. It is an exciting project and we are very keen to talk to charismatic UK psychotherapists, psychiatrists and other practitioners to participate. You may use CBT, CAT, drama/art therapy or any dynamic brief therapy, and be in private, public or corporate practice. Please call Rita Shamia on 0171 580 8686 or email kudos.productions@virgin.net.


New controls for sociopaths in England

Ministers said they intended to change the mental health laws to allow the indefinite detention of people who pose a risk to the public. They would either be held in prison or hospital, or in new purpose-built specialist units. There are an estimated 300 to 600 "dangerous severely personality disordered" adults currently in the community who could be detained in this way.

A consultation paper issued by the Home Office  said: "This means creating an environment in which dangerous people can be helped and encouraged to co-operate in therapeutic and other activity designed to help them return safely to the community. But if this does not reduce the risk they present, there may be no alternative but to continue to detain them indefinitely if the public is to be properly protected."

Jack Straw, Home Secretary, said: "Society has both a need and a right to protect itself from the actions of this small group of dangerous people, who because of their disordered personality pose an unacceptable level of risk. But in return for taking action to protect itself by detaining these people, possibly indefinitely, society incurs an obligation to provide effective services designed to help those people make the necessary changes in their behaviour so that they can return to the community safely."

Michael Howlett, director of the Zito Trust, said: "There are professions outside psychiatry, such as clinical psychology and psychotherapy, which do have the skills and the experience to work with people with these disorders.

He added: "If there is no new money coming in for these proposals then they simply will not work." Marjorie Wallace said: "While we do not believe in long-term detention for a person who has committed no offence, there are a small number of people who for their own protection and the protection of others should have specialised management and help which is neither punitive nor uses sorely stretched mental health resources."

A spokesman for the Royal College of Psychiatrists said  "Dangerousness is very difficult to predict. We are strongly opposed to changing the present Mental Health Act to make it legal to detain people with 'psychopathic disorder' in hospital against their wishes if they are deemed to be untreatable."

About 2,000 to 2,500 individuals - 98 per cent male - suffer from dangerous personality disorders. Most of them are already in prison or hospital.

The New NHS and Psychiatry

December 1997 saw the publication of the UK Labour Government's new White Paper on the health service, 'The New NHS'. The Paper promised an end to the short-lived Internal Market and heralds a supposed return to a collaborative culture rather than a competitive one.

Two days after the White Paper's publication Paul Boateng MP (Minister of State with responsibility for mental health and community care) set out how the new agenda would affect mental health services. At the King's College organised event, chaired by Sir David Goldberg, Paul Boateng said that the Government was committed to 'coherence, confidence and credibility' in mental health policy. He agreed that the 'no bed' concept of psychiatry was 'utterly discredited' and that there would always be a need for hospital psychiatry beds, but that re-provision of community services after the closure of institutions also needed investment. He acknowledged that the inner city provision of psychiatry beds was 'unsatisfactory'. The Government wanted to combat 'social exclusion'; ensure that services were sensitive to the needs of the ethnic minorities; that good services with a good attitude will be rewarded and that bad services with a bad attitude will not. He acknowledged problems with recruitment of staff and their retention.

In response to questions by Dr Ben Green, Editor, Paul Boateng said that use of both the Care Programme Approach and the Health of the Nation Outcome Scales would continue. Both initiatives had been legacies from the Conservative Government. Whilst underlining their potential usefulness the Minister commented that the tools themselves would need continual refinement to reduce bureaucracy and that in some areas of the country use was not being adhered to as required.

Sir David Goldberg, speaking at a King's College conference on the Government's new White Paper, reported that London's mental health services were the worst of all the UK cities he had looked at and that London required some 438 extra acute psychiatry beds, 623 24 hour staffed residential places and 155 low support housing places. He also pointed out how difficult it was to recruit and retain all members of the multidisciplinary team. He particularly criticised the waiting times that all patients endured before they got care and within the care process itself. He talked about dangerous, severely ill patients waiting days to be admitted and how 'routine' patients waiting for admission might never be admitted.

American Academy of Psychiatry and the Law Conference

The next conference is in New Orleans on 22-25 October 1998 and anyone wanting to fine tune their forensic psychiatry should go.

One gets a huge folder of all the notes plus the tapes of all the sessions in the course and if one wants, the tapes of the conference sessions are available one hour after the session finishes !

Dr Brian Boettcher

Forensic Psychiatrist

bboettch@mail.usyd.au

Antipsychotic Survey

Psychiatry On-Line has been running its own survey into psychiatrists' preferences amongst various available antipsychotic agents. We are pleased to summarise the results of the most recent 400 verified respondents to the survey below. The survey continues, as does the antidepressant survey.

The antipsychotic survey has detected a consolidation of the impact of the new drug, olanzapine. The drug now commands a preference rating of 7% of psychiatrists for use in new patients. This might not sound much compared to risperidone's preference rate of 30%. A high proportion of new preference loggings in the US and Canada are for olanzapine. Risperidone continues to hold a significant preference share in Europe and South America. The newer antipsychotics are likely to displace minority preferences (such as fluphenazine) from the top 5.

Arrows indicate the trend of preferences in recent months.

Psychiatry On-Line ® Antipsychotic Survey
Updated June 1997

Preferences	First Choice in First Episode n=400	Long-term Choice in Established Schizophrenia n=400
1	Haloperidol (37%)	Risperidone (36%) Stable
2	Risperidone (30%) Stable	Haloperidol (21%)
3	Olanzapine (7.1%)	Olanzapine(7.3%)
4	Chlorpromazine (4%)	Fluphenazine (6.1%)
5	Trifluoperazine(3.0%)	Flupenthixol(6.0%)

Section 25 Research

The UK Department of Health is making £240,000 available for research relevant to the evaluation of the 1995 Patients in the Community Act. Email rkirby.doh.sh@gtnet.gov.uk for more details, mentioning Psychiatry On-Line.

UK ECT Clinics performing poorly

An audit of 53 clinics in England and Wales showed that 70% were below par. 11 were officially poor and only 16 were good or exemplary. Half were not using recommended machines and two thirds of doctors administering ECT were very junior trainees. Nevertheless the audit showed an improvement since the previous audit of 1991. MIND, the national mental health charity, called for a wider audit still.

New plans for General Practice

The UK Department of Health published a new white paper about the future of General Practice in 1997.

Among it's recommendations were:

• An extension of nurse prescribing
• An extension of the role of pharmacists
• New minimum training standards for GP vocational training (summative assessment of registrars and more time spent in primary care)
• Health authorities can employ salaried doctors
• Fundholders can spend savings on new buildings
• Out of hours development fund will be made permanent
• Money for R&D will rise by 100%
• Inner cities to benefit from a new allocation formula
• Diversion of £32 million from hospitals for the community care of elderly and mentally ill.

This latter diversion will be seen as controversial by hard pressed hospital and community Trusts already struggling to implement the Government's underfunded Care Progreamme Approach.

 Creutzfeldt-Jakob Disease (Updated 10.5.97)

After protesting for some years that Bovine Spongiform Encephalopathy was NOT related to human dementias the UK Government has reluctantly admitted that a new variant of human CJD appears likely to be related to BSE.

The UK Chief Medical Officer has released the following figures, which are likely to be an underestimate, given that they rely on cases being reported to the UK Surveillance Unit, set up in 1990: