Psychiatry - Research Publications

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    Aging and cosmetic enhancement
    Honigman, R ; Castle, DJ (DOVE MEDICAL PRESS LTD, 2006)
    Obsession with a youthful appearance has become commonplace in modern society and has resulted in an upswing in cosmetic procedures trying to reverse the aging process. We selectively review the literature on aging and cosmetic surgery, with particular regard for the aging face. We pay attention to psychosocial aspects of response to such cosmetic procedures, both in terms of outcome and with respect to risk factors for a poor outcome.
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    Transitions of care from child and adolescent mental health services to adult mental health services (TRACK study): A study of protocols in greater London
    Singh, SP ; Paul, M ; Ford, T ; Kramer, T ; Weaver, T (BIOMED CENTRAL LTD, 2008-06-23)
    BACKGROUND: Although young people's transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) in England is a significant health issue for service users, commissioners and providers, there is little evidence available to guide service development. The TRACK study aims to identify factors which facilitate or impede effective transition from CAHMS to AMHS. This paper presents findings from a survey of transition protocols in Greater London. METHODS: A questionnaire survey (Jan-April 2005) of Greater London CAMHS to identify transition protocols and collect data on team size, structure, transition protocols, population served and referral rates to AMHS. Identified transition protocols were subjected to content analysis. RESULTS: Forty two of the 65 teams contacted (65%) responded to the survey. Teams varied in type (generic/targeted/in-patient), catchment area (locality-based, wider or national) and transition boundaries with AMHS. Estimated annual average number of cases considered suitable for transfer to AMHS, per CAMHS team (mean 12.3, range 0-70, SD 14.5, n = 37) was greater than the annual average number of cases actually accepted by AMHS (mean 8.3, range 0-50, SD 9.5, n = 33). In April 2005, there were 13 active and 2 draft protocols in Greater London. Protocols were largely similar in stated aims and policies, but differed in key procedural details, such as joint working between CAHMS and AMHS and whether protocols were shared at Trust or locality level. While the centrality of service users' involvement in the transition process was identified, no protocol specified how users should be prepared for transition. A major omission from protocols was procedures to ensure continuity of care for patients not accepted by AMHS. CONCLUSION: At least 13 transition protocols were in operation in Greater London in April 2005. Not all protocols meet all requirements set by government policy. Variation in protocol-sharing organisational units and transition process suggest that practice may vary. There is discontinuity of care provision for some patients who 'graduate' from CAMHS services but are not accepted by adult services.
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    A group intervention which assists patients with dual diagnosis reduce their drug use: a randomized controlled trial
    James, W ; Preston, NJ ; Koh, G ; Spencer, C ; Kisely, SR ; Castle, DJ (CAMBRIDGE UNIV PRESS, 2004-08)
    BACKGROUND: There is a well-recognized association between substance use and psychotic disorders, sometimes described as 'dual diagnosis'. The use of substances by people with psychosis has a negative impact in terms of symptoms, longitudinal course of illness and psychosocial adjustment. There are few validated treatments for such individuals, and those that do exist are usually impracticable in routine clinical settings. The present study employs a randomized controlled experimental design to examine the effectiveness of a manualized group-based intervention in helping patients with dual diagnosis reduce their substance use. METHOD: The active intervention consisted of weekly 90-min sessions over 6 weeks. The manualized intervention was tailored to participants' stage of change and motivations for drug use. The control condition was a single educational session. RESULTS: Sixty-three subjects participated, of whom 58 (92%) completed a 3-month follow-up assessment of psychopathology, medication and substance use. Significant reductions in favour of the treatment condition were observed for psychopathology, chlorpromazine equivalent dose of antipsychotics, alcohol and illicit substance use, severity of dependence and hospitalization. CONCLUSIONS: It is possible to reduce substance use in individuals with psychotic disorders, using a targeted group-based approach. This has important implications for clinicians who wish to improve the long-term outcome of their patients.
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    The diagnostic interview for psychoses (DIP): development, reliability and applications
    Castle, DJ ; Jablensky, A ; McGrath, JJ ; Carr, V ; Morgan, V ; Waterreus, A ; Valuri, G ; Stain, H ; McGuffin, P ; Farmer, A (CAMBRIDGE UNIV PRESS, 2006-01)
    BACKGROUND: We describe the development, reliability and applications of the Diagnostic Interview for Psychoses (DIP), a comprehensive interview schedule for psychotic disorders. METHOD: The DIP is intended for use by interviewers with a clinical background and was designed to occupy the middle ground between fully structured, lay-administered schedules, and semi-structured, psychiatrist-administered interviews. It encompasses four main domains: (a) demographic data; (b) social functioning and disability; (c) a diagnostic module comprising symptoms, signs and past history ratings; and (d) patterns of service utilization and patient-perceived need for services. It generates diagnoses according to several sets of criteria using the OPCRIT computerized diagnostic algorithm and can be administered either on-screen or in a hard-copy format. RESULTS: The DIP proved easy to use and was well accepted in the field. For the diagnostic module, inter-rater reliability was assessed on 20 cases rated by 24 clinicians: good reliability was demonstrated for both ICD-10 and DSM-III-R diagnoses. Seven cases were interviewed 2-11 weeks apart to determine test-retest reliability, with pairwise agreement of 0.8-1.0 for most items. Diagnostic validity was assessed in 10 cases, interviewed with the DIP and using the SCAN as 'gold standard': in nine cases clinical diagnoses were in agreement. CONCLUSIONS: The DIP is suitable for use in large-scale epidemiological studies of psychotic disorders, as well as in smaller studies where time is at a premium. While the diagnostic module stands on its own, the full DIP schedule, covering demography, social functioning and service utilization makes it a versatile multi-purpose tool.
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    Drawing conclusions about cannabis and psychosis
    Castle, D (CAMBRIDGE UNIV PRESS, 2008-03)
    The renewed interest in the association between cannabis and mental illness is well reflected in three articles and a commentary in volume 37, number 7, of Psychological Medicine.