Aims and Method To engage patients as teachers of psychiatrists in training and non-consultant ca... more Aims and Method To engage patients as teachers of psychiatrists in training and non-consultant career grades, for the purpose of enhancing doctors' understanding of the patient point of view and of the complexity of the doctor–patient relationship. Patients have been engaged as teachers in a recurrent cycle of ‘Basic Interview Skills' workshops and the views of the doctors about this initiative have been elicited through a brief anonymous and confidential questionnaire. Results Thirty-six psychiatric senior house officers (SHOs), general practitioners, Vocational Training Scheme SHOs in psychiatry, and staff grade and trust doctors in psychiatry have participated in four cycles of workshops. Five patients have engaged in the workshops as teachers, alongside the clinical tutor. Questionnaire feedback indicated some specific criticisms of a number of participants and dissatisfaction by a small minority of doctors, but the overall evaluation of the experience was positive. Clin...
According to Beauchamp & Childress (2001) the fundamental principles of biomedical ethics include... more According to Beauchamp & Childress (2001) the fundamental principles of biomedical ethics include ‘justice'. But how do we approach ‘justice'? Justice may be thought of in relation to an individual or society. An individual may be just or unjust. Justice in society may be thought of as ‘retributive justice’ (fair punishment), ‘civil justice’ (fair recompense), ‘distributive justice’ (fair shares) or ‘social justice’ (a fair social contract for citizens of a society).
Abstract In order to solve the shortcomings of conventional active sonar transmitters, a new arch... more Abstract In order to solve the shortcomings of conventional active sonar transmitters, a new architecture of full digital transmitter was proposed. The proposed architecture focused on the reconfiguration of the transmitter structure and the improvement on the control mode of the power amplifier. Many devices of traditional transmitters were removed, and the waveform generator, transmitting beamforming, PWM signals generation and dead-time control were implemented in the FPGA. The digital transmitter can reduce the complexity of active sonar system, and improve the reliability of the transmitter. The simulations and experiments show that the proposed transmitter is reliable and meets the design requirements.
At the turn of a new decade how might the futures of psychiatrists look? Here we address issues o... more At the turn of a new decade how might the futures of psychiatrists look? Here we address issues of social inclusion and, also, the professional identity and relationships of psychiatrists.
Spurred by Literature Nobel Laureate Svetlana Alexievich’s empathic reports in Secondhand time: T... more Spurred by Literature Nobel Laureate Svetlana Alexievich’s empathic reports in Secondhand time: The last of the Soviets—An Oral History (2016b), the authors reflect on the dynamics of suicide and self-harm at individual and communal and national levels. Themes explored in relation to two of Alexievich’s individual cases of suicide, the demise of the Communist Party of the Soviet Union and the Soviet Union itself, as well as the result of the Brexit referendum, include feelings of hopelessness, fantasies and experiences of transcendence and the will to control. The necessity of a pluralistic perspective and the possibility of complementary or alternative understandings of Alexievich’s accounts and the people and events discussed in this article are acknowledged.
The General Medical Council has introduced a generic professional capabilities framework. It incl... more The General Medical Council has introduced a generic professional capabilities framework. It includes the need to develop the professional values, actions and aspirations fundamental to becoming a ‘dedicated doctor’. The history of psychiatry has potential to facilitate this learning, both by an understanding of content and the ability to think historically.
SUMMARY The authors summarise the evolving understanding of the neuropsychophysiology of chronic ... more SUMMARY The authors summarise the evolving understanding of the neuropsychophysiology of chronic pain, including the relevance of adverse childhood experiences in facilitating it and similarities between the central physiology of chronic pain and opioid addiction. Emerging understanding highlights the importance of dopamine-expressing GABAergic neurons in the nucleus accumbens and suggests that D1 expression is associated with a sense of pleasure and approach behaviour and D2 with a sense of punishment and behavioural inhibition. Regulation of D1 and D2 expression may be mediated by nigrostriatal and medial frontal striatal pathways within the increasingly understood brain as a ‘predictive’ organ. The distinction between the predictive brain and personal ‘expectations’ and the importance of the latter for clinical outcomes are emphasised. The relevance of findings for possible future psychopharmacological treatment avenues is also presented.
Spinal cord injury is an uncommon condition, potentially causing a wide range of consequences and... more Spinal cord injury is an uncommon condition, potentially causing a wide range of consequences and requiring specialist rehabilitation to optimize health, activity and participation. Early psychological response to injury and relations with staff, as well as family, may set the foundations for long-term emotional adjustment, healthcare utilization and quality of life. The Stanmore Nursing Assessment of Psychological Status has been developed at the London Spinal Cord Injury Centre to empower nurses to adopt a consistently empathic approach to patient care, as part of a comprehensive range of rehabilitation team skills. Its use in other spinal cord injury centers and a broader range of clinical environments (hospital and community) should therefore be considered.
International journal of environmental research and public health, Jan 20, 2018
Since the 1960s, we have witnessed the development and growth of community mental health care tha... more Since the 1960s, we have witnessed the development and growth of community mental health care that continues to dominate mental health policy and practice. Several high-income countries have implemented community mental health care programmes but for many others, including mostly low- and middle-income countries, it remains an aspiration. Although community mental health care has been positive for many service users, it has also had severe shortcomings. Expectations that it would lead to fuller social integration have not been fulfilled and many service users remain secluded in sheltered or custodial environments with limited social contacts and no prospect of work. Others receive little or no service at all. In today’s complex landscape of increasingly specialised services for people with mental health problems, the number of possible interfaces between services is increasing. Together with existing uneven financing systems and a context of constant change, these interfaces a...
Aims and Method To engage patients as teachers of psychiatrists in training and non-consultant ca... more Aims and Method To engage patients as teachers of psychiatrists in training and non-consultant career grades, for the purpose of enhancing doctors' understanding of the patient point of view and of the complexity of the doctor–patient relationship. Patients have been engaged as teachers in a recurrent cycle of ‘Basic Interview Skills' workshops and the views of the doctors about this initiative have been elicited through a brief anonymous and confidential questionnaire. Results Thirty-six psychiatric senior house officers (SHOs), general practitioners, Vocational Training Scheme SHOs in psychiatry, and staff grade and trust doctors in psychiatry have participated in four cycles of workshops. Five patients have engaged in the workshops as teachers, alongside the clinical tutor. Questionnaire feedback indicated some specific criticisms of a number of participants and dissatisfaction by a small minority of doctors, but the overall evaluation of the experience was positive. Clin...
According to Beauchamp & Childress (2001) the fundamental principles of biomedical ethics include... more According to Beauchamp & Childress (2001) the fundamental principles of biomedical ethics include ‘justice'. But how do we approach ‘justice'? Justice may be thought of in relation to an individual or society. An individual may be just or unjust. Justice in society may be thought of as ‘retributive justice’ (fair punishment), ‘civil justice’ (fair recompense), ‘distributive justice’ (fair shares) or ‘social justice’ (a fair social contract for citizens of a society).
Abstract In order to solve the shortcomings of conventional active sonar transmitters, a new arch... more Abstract In order to solve the shortcomings of conventional active sonar transmitters, a new architecture of full digital transmitter was proposed. The proposed architecture focused on the reconfiguration of the transmitter structure and the improvement on the control mode of the power amplifier. Many devices of traditional transmitters were removed, and the waveform generator, transmitting beamforming, PWM signals generation and dead-time control were implemented in the FPGA. The digital transmitter can reduce the complexity of active sonar system, and improve the reliability of the transmitter. The simulations and experiments show that the proposed transmitter is reliable and meets the design requirements.
At the turn of a new decade how might the futures of psychiatrists look? Here we address issues o... more At the turn of a new decade how might the futures of psychiatrists look? Here we address issues of social inclusion and, also, the professional identity and relationships of psychiatrists.
Spurred by Literature Nobel Laureate Svetlana Alexievich’s empathic reports in Secondhand time: T... more Spurred by Literature Nobel Laureate Svetlana Alexievich’s empathic reports in Secondhand time: The last of the Soviets—An Oral History (2016b), the authors reflect on the dynamics of suicide and self-harm at individual and communal and national levels. Themes explored in relation to two of Alexievich’s individual cases of suicide, the demise of the Communist Party of the Soviet Union and the Soviet Union itself, as well as the result of the Brexit referendum, include feelings of hopelessness, fantasies and experiences of transcendence and the will to control. The necessity of a pluralistic perspective and the possibility of complementary or alternative understandings of Alexievich’s accounts and the people and events discussed in this article are acknowledged.
The General Medical Council has introduced a generic professional capabilities framework. It incl... more The General Medical Council has introduced a generic professional capabilities framework. It includes the need to develop the professional values, actions and aspirations fundamental to becoming a ‘dedicated doctor’. The history of psychiatry has potential to facilitate this learning, both by an understanding of content and the ability to think historically.
SUMMARY The authors summarise the evolving understanding of the neuropsychophysiology of chronic ... more SUMMARY The authors summarise the evolving understanding of the neuropsychophysiology of chronic pain, including the relevance of adverse childhood experiences in facilitating it and similarities between the central physiology of chronic pain and opioid addiction. Emerging understanding highlights the importance of dopamine-expressing GABAergic neurons in the nucleus accumbens and suggests that D1 expression is associated with a sense of pleasure and approach behaviour and D2 with a sense of punishment and behavioural inhibition. Regulation of D1 and D2 expression may be mediated by nigrostriatal and medial frontal striatal pathways within the increasingly understood brain as a ‘predictive’ organ. The distinction between the predictive brain and personal ‘expectations’ and the importance of the latter for clinical outcomes are emphasised. The relevance of findings for possible future psychopharmacological treatment avenues is also presented.
Spinal cord injury is an uncommon condition, potentially causing a wide range of consequences and... more Spinal cord injury is an uncommon condition, potentially causing a wide range of consequences and requiring specialist rehabilitation to optimize health, activity and participation. Early psychological response to injury and relations with staff, as well as family, may set the foundations for long-term emotional adjustment, healthcare utilization and quality of life. The Stanmore Nursing Assessment of Psychological Status has been developed at the London Spinal Cord Injury Centre to empower nurses to adopt a consistently empathic approach to patient care, as part of a comprehensive range of rehabilitation team skills. Its use in other spinal cord injury centers and a broader range of clinical environments (hospital and community) should therefore be considered.
International journal of environmental research and public health, Jan 20, 2018
Since the 1960s, we have witnessed the development and growth of community mental health care tha... more Since the 1960s, we have witnessed the development and growth of community mental health care that continues to dominate mental health policy and practice. Several high-income countries have implemented community mental health care programmes but for many others, including mostly low- and middle-income countries, it remains an aspiration. Although community mental health care has been positive for many service users, it has also had severe shortcomings. Expectations that it would lead to fuller social integration have not been fulfilled and many service users remain secluded in sheltered or custodial environments with limited social contacts and no prospect of work. Others receive little or no service at all. In today’s complex landscape of increasingly specialised services for people with mental health problems, the number of possible interfaces between services is increasing. Together with existing uneven financing systems and a context of constant change, these interfaces a...
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Papers by George Ikkos