Community Medical Services

Adjustment disorder has been included in the psychiatric classifications for half a century, but despite its age, this is the first book devoted exclusively to the condition. The starting point is to delineate its origins and how it differs from normal distress. The philosophical and clinical dilemmas raised by this diagnosis are considered in the early chapters of this book. The development of new screening and diagnostic tools will assist in epidemiological studies. The radical proposal to have specific criteria for AD in ICD-11 is reviewed critically as this would lead to significant differences between DSM-5 and ICD-11. Psychobiology, treatment, and prognosis are discussed in the middle sections of this work, and specialists in a number of areas—including child and adolescent psychiatry, learning disability, occupational health, and forensic psychiatry—have made invaluable contributions. This book will fill the vacuum for doctors and other mental health professionals working with those who have AD. The generous use of case vignettes invigorates the theory behind the practice.Less

Containing detailed summaries on a comprehensive range of clinical scenarios and conditions, and organised according to the different sub-specialities of community paediatrics, this resource is an ideal companion for anyone working with children in the community.Less

The last 50 years has witnessed a radical change in the care of the severely mentally ill as asylums have closed and care has moved to the community. Two developments have marked this transition. The first is the development of multidisciplinary community mental health teams (CMHTs). The second is an increasing reliance on outreach to engage and support the most seriously ill patients. This book is a guide for those, whatever their professional background, who work in CMHTs. It focuses on the practicalities of the job—what they all need to know, whether coming to it from social work, nursing, or psychology. It is based on our decade of working together in an assertive outreach team and our backgrounds in nursing and psychiatry in a range of CMHTs.The book is in three parts. The first addresses the underlying principles of the practice and its variations. It explores the themes that are common to all outreach work and the specific thinking and practice characterizing different teams and settings. The second section addresses the range of problems faced by the outreach worker. These include the challenges presented by different diagnoses, plus those of hostility, homelessness, suicidality, and the omnipresent complications of drug and alcohol abuse. Psychosocial interventions aimed to promote employment and social stability are outlined with clinical examples. The third section explores the structural issues of managing the team, providing effective supervision, and conducting research. We draw on relevant research when appropriate, but the style of the book is practical, based primarily on accumulated experience.Less

This resource is the essential guide to caring for patients in primary care and the community and covers the skills and knowledge required by any nurse working in modern primary and community care, which cuts across different speciality and care settings. Topics covered range from common adult health problems to vulnerable groups with extra needs, medicine management, and nurse prescribing. It includes information on how health and social care services are organised and funded, from common technical care procedures to complex situations requiring practical, concise guidance. The new edition includes revised and expanded material on end of life care, with more focus on care of dying children. It also includes new clinical topics such as nursing technology, dependent children at home, and frailty.Less

This comprehensive, evidence-informed text provides clinicians, researchers, policy-makers and academicians, with content to inform and enrich the guidelines recommended by the National Consensus Project and the National Quality Forum Preferred Practices. It is designed to meet the needs of health social work professionals who seek to provide culturally sensitive biopsychosocial-spiritual care for patients and families living with life-threatening illness. Edited by two of the leading social work clinician-researchers in the US, this text serves as the definitive resource for practicing clinicians and fulfils the need for social work faculty who wish to complement general health care texts with information specific to palliative and end-of-life care.Less

Cultures are defined in many ways and may mean different things. Culture consists of meanings, symbols, and ways of living that are shared by a group of people and within consists of microidentities which are related to gender, religion, sexual orientation, and many other factors. Cultures influence our world view, child rearing, responses to distress, explanatory models, and pathways into professional care. Increasingly, clinicians in medicine, but in psychiatry in particular, have become aware of the way that culture affects precipitating distress, its perpetuation, and prognosis. Cultures and society determine how healthcare is funded. Cultures are not confined to patients; health professionals also carry their own cultures related to professional values and training. Therefore it is important for healthcare professionals to be culturally competent, which reflects good clinical practice. In this volume, practical ways of assessing and managing patients are described, especially for those patients whose cultural background may be different from those of clinicians. It is critical to understand the impact of culture on individuals, their families, and their carers. Assessment using clinical tools needs to be culturally appropriate and sensitive too. Instruments for assessment need to be valid and culturally appropriate. Cultural formulations are helpful in ascertaining contributing and relieving factors. Engaging therapeutically and developing a therapeutic alliance is at the heart of successful patient outcomes. The impact of culture on presentation is described. Using medications in appropriate ways is explained, along with pharmacokinetics and pharmacodynamics.Less

Within general psychiatry, awareness of autism spectrum disorder (ASD) and the use of the terms ‘autism’, ‘autistic disorder’, ‘Asperger syndrome’, the ‘autism spectrum’, and ‘high functioning autism’ (HFA) are growing. However, autism has yet to become part of the accepted mainstream, core curriculum of general psychiatry. Psychiatrists are now expected to be able to recognize autism and consider its effects on their adult patients, particularly those showing signs of comorbid mental disorder, for example, schizophrenia, personality disorder, mood disorder, or attention-deficit/hyperactivity disorder (ADHD). From childhood through to adulthood and old age there is a failure in autism to develop skills in reciprocal social interaction, understanding, and flexibility. This can profoundly affect behaviour in the community, personal independence, employability, and social relationships, including marriage and parenting. Most cases of autism in adults are unrecognized and undiagnosed, both within the general population and in adults using psychiatric services. This book gives a comprehensive introduction to autism and Asperger syndrome written to fit the adult clinician’s perspective. It will assist with autism recognition and diagnosis in adulthood. It is designed to enhance the clinician’s role in treating patients with co-morbid mental disorder, while understanding and taking account of the autism component. It will also help in signposting patients with autism to appropriate care and support, as family involvement diminishes, or ceases in adulthood and old age, and in the psychiatrist’s role in providing advice to the courts and in the context of detention in accordance with mental health law.Less

This book presents a collection of chapters written by women psychiatrists working in, or who have recently worked in, the National Health Service (NHS). In addition, there are chapters by a medical journalist and a senior NHS mental health nurse manager, as well as short profiles of some women whose work has made a difference to psychiatry. The subjects covered are diverse and include descriptions of women’s roles in perinatal psychiatry, women-only units, forensic, old age, and intellectual difficulties services. There are chapters analysing roles of women as psychiatry trainees and trainers, as managers, and as doctors with mental illnesses. Chapters on the history of women in medicine and psychiatry are included. The modern legal framework for decision-making for vulnerable people is covered and the psychoanalytical perspective is particularly emphasized in chapters on historic abuse and the functioning of mental health units. Some chapters are autobiographical and some are biographical. This book is of interest to specialists and non-specialists alike and explores some of the main changes to mental health services in the twentieth century, from the perspective of women doctors. These chapters will help reduce stigma about mental illnesses and demystify the world of psychiatry. Young readers may be inspired to consider careers in this fascinating field that not only seeks to understand the human mind but also uses science and evidence to improve psychiatric treatments.Less