scholarly journals After Pool : Good practice guidelines for expert psychiatric witnesses

2017 ◽  
Vol 23 (6) ◽  
pp. 385-394 ◽  
Author(s):  
Keith Rix ◽  
Nigel Eastman ◽  
Anthony Haycroft
Keyword(s):  
Expert Opinion ◽  
Practice Guidelines ◽  
Expert Witness ◽  
Good Practice ◽  
Learning Objectives ◽  
Logical Analysis ◽  
List Type ◽  
Type Number ◽  
Administration Of Justice ◽  
The Supreme Court

SummaryActing as an expert psychiatric witness can be rewarding, but there are potential costs and pitfalls, such that the role should be undertaken only in an informed manner. With reference to the recent disciplinary cases of Dr Richard Pool and Dr Waney Squier, and a judgment of the Supreme Court, advice is offered to potential expert psychiatric witnesses. Suggestions are made as to training, the negotiation of instructions, the citation of published literature, the construction of expert opinion and how to ensure compliance with the ethical duties of the expert witness.LEARNING OBJECTIVES•Understand how psychiatric trainees can be prepared for assisting the courts and tribunals in the administration of justice•Appreciate the importance of engaging in a frank discussion with potential instructing solicitors, prior to instruction, regarding areas of expertise and working knowledge, providing a balanced interpretation of the psychiatric literature and giving reasoned opinions that withstand logical analysis•Know what processes can be used to enhance compliance with the ethical responsibilities of the expert psychiatric witness

scholarly journals Metabolic syndrome in psychiatry: advances in understanding and management

2014 ◽  
Vol 20 (2) ◽  
pp. 101-112 ◽  
Author(s):  
Cyrus S. H. Ho ◽  
Melvyn W. B. Zhang ◽  
Anselm Mak ◽  
Roger C. M. Ho
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Psychiatric Disorders ◽  
Psychiatric Patients ◽  
Learning Objectives ◽  
List Type ◽  
Type Number ◽  
Unhealthy Lifestyle ◽  
Definition Of ◽  
The Relationship

SummaryMetabolic syndrome comprises a number of cardiovascular risk factors that increase morbidity and mortality. The increase in incidence of the syndrome among psychiatric patients has been unanimously demonstrated in recent studies and it has become one of the greatest challenges in psychiatric practice. Besides the use of psychotropic drugs, factors such as genetic polymorphisms, inflammation, endocrinopathies and unhealthy lifestyle contribute to the association between metabolic syndrome and a number of psychiatric disorders. In this article, we review the current diagnostic criteria for metabolic syndrome and propose clinically useful guidelines for psychiatrists to identify and monitor patients who may have the syndrome. We also outline the relationship between metabolic syndrome and individual psychiatric disorders, and discuss advances in pharmacological treatment for the syndrome, such as metformin.LEARNING OBJECTIVES•Be familiar with the definition of metabolic syndrome and its parameters of measurement.•Appreciate how individual psychiatric disorders contribute to metabolic syndrome and vice versa.•Develop a framework for the prevention, screening and management of metabolic syndrome in psychiatric patients.

scholarly journals Managing delirium in everyday practice: towards cognitive-friendly hospitals

2014 ◽  
Vol 20 (6) ◽  
pp. 380-389 ◽  
Author(s):  
Henry O'Connell ◽  
Sean P. Kennelly ◽  
Walter Cullen ◽  
David J. Meagher
Keyword(s):  
Healthcare System ◽  
Clinical Care ◽  
Cognitive Disorder ◽  
Learning Objectives ◽  
Everyday Practice ◽  
List Type ◽  
Type Number ◽  
Hospital Environments ◽  
Cognitive Problems ◽  
The Way

SummaryProviding optimal healthcare for increasingly elderly hospital populations who have high rates of cognitive disorder is a great challenge. Using delirium as an example, we describe how improved management of acute cognitive problems through a multifaceted hospital-wide programme can promote cognitive-friendly hospital environments. A specific plan of action is described that spans interventions in day-to-day clinical care of individual patients all the way to wider organisational practices.Learning Objectives•Understand the concept of cognitive friendliness and how addressing the problem of delirium can contribute to this in our healthcare system.•Become more aware of specific aspects of a cognitive-friendly programme and how these can be implemented in practice.•Explore the key outstanding issues for research that can further enhance our awareness of cognitive-friendly practices.

scholarly journals The interface between general and forensic psychiatry: the present day

2014 ◽  
Vol 20 (5) ◽  
pp. 359-365 ◽  
Author(s):  
Vivek Khosla ◽  
Phil Davison ◽  
Harvey Gordon ◽  
Verghese Joseph
Keyword(s):  
Forensic Psychiatry ◽  
Clinical Care ◽  
Learning Objectives ◽  
List Type ◽  
Type Number ◽  
England And Wales ◽  
Adult Psychiatry ◽  
The Republic ◽  
Definition Of ◽  
The Uk

SummaryWith the subspecialisation of psychiatry in the UK, clinicians encounter problems at the interfaces between specialties. These can lead to tension between clinicians, which can be unhelpful to the clinical care of the patient. This article focuses on the interface between general and forensic psychiatry in England and Wales. The pattern of mental health services in England and Wales differs to an extent from those in Scotland, Northern Ireland and in the Republic of Ireland. Consequently, the interface between general and forensic psychiatry is subject to varying influences. Important interface issues include: the definition of a ‘forensic patient’; the remit and organisation of services; resources; clinical responsibility; and care pathways. This article also discusses a general overview of how to improve collaboration between forensic and general adult psychiatric services.Learning Objectives•Develop an understanding of important issues at the forensic/general adult psychiatry interface.•Be aware of areas of conflict that may arise at the forensic/general adult psychiatry interface.•Be aware of options for optimum cooperation at the interface.

scholarly journals Miscarriages of justice and expert psychiatric evidence: lessons from criminal appeals in England and Wales

2019 ◽  
Vol 25 (4) ◽  
pp. 251-264 ◽  
Author(s):  
Nicholas Hallett ◽  
Nadine Smit ◽  
Keith Rix
Keyword(s):  
Criminal Justice ◽  
Criminal Justice System ◽  
Justice System ◽  
Learning Objectives ◽  
List Type ◽  
Criminal Cases ◽  
England And Wales ◽  
Direct Bearing ◽  
Administration Of Justice ◽  
Court Of Appeal

SUMMARYMiscarriages of justice occur as a result of unsafe convictions and findings and inappropriate sentences. In cases involving expert psychiatric evidence it is possible that the way evidence is presented by experts or interpreted by the courts has a direct bearing on the case. Using illustrative cases from the Criminal Division of the Court of Appeal, advice is offered to expert psychiatric witnesses on ways to reduce the likelihood of contributing to such miscarriages of justice and on how they may assist in rectifying such miscarriages, should they occur.LEARNING OBJECTIVESAfter reading this article you will be able to: •understand the place of criminal appeals in the criminal justice system in England and Wales•understand what may go wrong in the provision of psychiatric evidence and how expert psychiatric evidence can assist in the administration of justice•be able to reduce the risk of unsafe convictions and inappropriate sentences when providing expert psychiatric evidence, including for cases referred to the Court of Appeal and the Criminal Cases Review Commission.DECLARATION OF INTERESTNone.

scholarly journals Autoimmune encephalitis: a potentially treatable cause of mental disorder

2014 ◽  
Vol 20 (2) ◽  
pp. 92-100 ◽  
Author(s):  
Hugh Rickards ◽  
Saiju Jacob ◽  
Belinda Lennox ◽  
Tim Nicholson
Keyword(s):  
Autoimmune Encephalitis ◽  
Mental States ◽  
Learning Objectives ◽  
First Episode ◽  
List Type ◽  
Type Number ◽  
Red Flags ◽  
Episode Psychosis ◽  
Autonomic Instability ◽  
Red Flag

SummaryAutoimmune encephalitides can present with altered mental states, particularly psychosis and delirium. Psychiatrists need to be particularly vigilant in cases of first-episode psychosis and to look out for other, sometimes subtle, features of encephalitis. Encephalitis related to N-methyl-d-aspartate (NMDA) receptor autoantibodies is the most common autoimmune cause of isolated psychosis, the second being related to voltage-gated potassium channel (VGKC)-complex antibodies. Psychiatrists should note ‘red flag’ signs of seizures, autonomic instability, movement disorders and sensitivity to antipsychotic medication (including neuroleptic malignant syndrome). They should also be aware that, in some cases, encephalitis is a non-metastatic manifestation of malignancy. Treatment primarily involves suppression of immunity and is often successful if delivered early. There is accumulating evidence that isolated psychiatric syndromes can be caused by autoimmunity and this could potentially signal a significant change in the approach to disorders such as schizophrenia. Psychiatrists and neurologists need to work together to diagnose, manage and understand this group of conditions.LEARNING OBJECTIVES•Consider ‘red flags' for the diagnosis of autoimmune encephalitis presenting to general psychiatric practice.•Understand the investigations required to diagnose autoimmune encephalitis.•Become familiar with the basics of treatment of autoimmune encephalitis.

scholarly journals Assisted dying – the debate: Videtur… sed contra

2014 ◽  
Vol 20 (4) ◽  
pp. 250-257
Author(s):  
Philip Graham ◽  
Julian C. Hughes
Keyword(s):  
Health Professionals ◽  
Empirical Data ◽  
Terminally Ill ◽  
Learning Objectives ◽  
List Type ◽  
Assisted Dying ◽  
Type Number ◽  
The Law ◽  
The Uk

SummaryShould the law be changed to allow health professionals to assist mentally competent, terminally ill people to end their own lives? In this article Philip Graham (P.G.) puts the arguments in favour of such a change in the law and Julian Hughes (J.H.) opposes these arguments. J.H. then sets out why he believes such a law should not be passed and P.G., in turn, sets out counterarguments. Before concluding comments, both P.G. and J.H. independently make brief closing statements supporting their own positions.LEARNING OBJECTIVESUnderstand the differences between various types of ‘assisted dying’.Appreciate some of the ethical arguments in favour of and against changes in the law on assisted dying in the UK.Understand some of the empirical data involved in arguments about assisted dying.

scholarly journals A comparison of DSM and ICD classifications of mental disorder

2014 ◽  
Vol 20 (4) ◽  
pp. 280-285 ◽  
Author(s):  
Peter Tyrer
Keyword(s):  
Mental Disorder ◽  
Learning Objectives ◽  
List Type ◽  
Type Number ◽  
Behavioural Disorders ◽  
Major Player ◽  
The Usa ◽  
History Of ◽  
Pros And Cons ◽  
Research Classification

SummaryMost disorders in medicine are classified using the ICD (initiated in Paris in 1900). Mental and behavioural disorders are classified using the DSM (DSM-I was published in the USA in 1952), but it was not until DSM-III in 1980 that it became a major player. Its success was largely influenced by Robert Spitzer, who welded its disparate elements, and Melvyn Shabsin, who facilitated its acceptance. Spitzer pointed out that most diagnostic conditions in psychiatry were poorly defined, showed poor reliability in test-retest situations, and were temporally unstable. The consequence was that the beliefs of the psychiatrist seemed to matter much more than the characteristics of the patient when it came to classification. Since DSM-III there has been a split between those who adhere to DSM because it is a better research classification and those who adhere to ICD because it allows more clinical discretion in making diagnoses. This article discusses the pros and cons of both systems, and the major criticisms that have been levelled against them.LEARNING OBJECTIVESUnderstand the principles and reasoning behind classification in medicine and psychiatry.Be able to describe the recent history of psychiatric classification.Be able to compare DSM and ICD classifications of mental disorder.

scholarly journals Canadian Association of Neuropathologists Workforce Survey, 2019

2021 ◽  
Vol 48 (s1) ◽  
pp. S6-S6
Author(s):  
P Shannon
Keyword(s):  
Learning Objectives ◽  
List Type ◽  
Full Time ◽  
Type Number ◽  
Full Time Equivalent ◽  
Canadian Association ◽  
Ophthalmic Pathology ◽  
Professional Occupation ◽  
E Mail ◽  
Anatomical Pathology

To characterize the professional occupation of Canadian neuropathologists and estimate the future employment demands in neuropathologists, all the active members of the Canadian Association of Neuropathologists in Canada (n=53) were surveyed by E-mail, inquiring as to their estimated date of retirement, their current employment and practice profile, and as to any practice trends they had noticed. 49 members replied: all but one practice at medical school centers. 38 practice exclusively in neuropathology and three of these are employed at less than 75% of a full time equivalent. The remaining practices are mixed neuropathology and anatomical pathology, and one practices exclusively ophthalmic pathology. 35% reported significant neuropathology sub specialization (e.g. forensic, pediatric, neuromuscular). 42% reported greater than 10% of time dedicated to research (of these, median 30%) and 35% greater than 10% time spent in teaching, and 9% greater than 10% time in administration. Of the 49 surveyed, as of the spring of 2019, 14%(seven) of the full time neuropathologists can be expected to retire in the next 10 years, and 6% (three) with mixed AP/NP practices.LEARNING OBJECTIVESThis presentation will enable the learner to: 1.Understand the current spectrum of practice of Neuropathologists across Canada2.Describe the patterns of employment and anticipated retirements of Canadian Neuropathologists

scholarly journals Role of MacroH2A2 in the glioblastoma stem cell epigenome

2019 ◽  
Vol 46 (s2) ◽  
pp. S65
Author(s):  
A Nikolic ◽  
K Ellestad ◽  
M Johnston ◽  
PB Dirks ◽  
FJ Zemp ◽  
...  
Keyword(s):  
Histone Variant ◽  
Learning Objectives ◽  
List Type ◽  
Type Number ◽  
Rna Seq ◽  
Self Renewal ◽  
Malignant Brain Tumour ◽  
Glioblastoma Stem Cell ◽  
Patient Prognosis

Glioblastoma is the most common primary malignant brain tumour in adults, and remains uniformly lethal. These tumours contain a subpopulation of glioblastoma stem cells (GSCs) that drive tumour recurrence and drug resistance. We find that MacroH2A2 is a histone variant that can stratify glioblastoma patients, with higher levels of this histone variant associated with better patient prognosis. Knockdown of macroH2A2 in GSCs is associated with increased self-renewal and an increased expression of stemness genes by RNA-seq. Our preliminary results suggest that macroH2A2 is a novel biomarker for glioblastoma and that macroH2A2 loss is a marker of GSC stemness and a poor prognostic marker in glioblastoma. This work identifies loss of macroH2A2 as a feature of GSCs and provides a framework for therapeutic modulation of this histone variant.LEARNING OBJECTIVESThis presentation will enable the learner to:1.Explain the role of epigenetics in glioblastoma pathophysiology

scholarly journals Severe and enduring eating disorders: recognition and management

2014 ◽  
Vol 20 (6) ◽  
pp. 392-401 ◽  
Author(s):  
Paul Robinson
Keyword(s):  
Eating Disorders ◽  
Crisis Management ◽  
Learning Objectives ◽  
Psychological State ◽  
Service Development ◽  
List Type ◽  
Type Number ◽  
Specific Group ◽  
Definition Of

SummaryPatients with severe and enduring eating disorders (SEED) may constitute a specific group. It is proposed that patients with anorexia nervosa (SEED-AN) or bulimia nervosa (SEED-BN) that requires the regular attention of a multidisciplinary team and is of a duration known to have a low recovery rate should be included in the SEED group. These patients present with a combination of severe symptoms and long-term illness, and may experience serious chronic physical sequelae (e.g. osteoporosis and renal failure), marked social isolation and stigma. Their carers suffer from the stress of caring for them over a prolonged period. Symptoms, treatment and crisis management of SEED-AN are discussed. SEED is a relatively recently described area of eating disorders psychiatry that requires research and service development so that patients and carers are helped to cope with very serious chronic, but not incurable, conditions.Learning Objectives•Understand the definition of SEED-AN and SEED-BN.•Be able to assess the physical and psychological state of patients with SEED-AN and SEED-BN.•Be able to plan the monitoring and treatment of patients with SEED, involving their carers and families.

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