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

Caregivers delivering care to breast cancer patients wish to provide the highest quality breast care possible. Due to the complexity of the care pathway, this care should be delivered by a multidisciplinary team working in a breast cancer unit/centre. This book was written by experts from different disciplines and presents ideas for developing a breast unit wherever you live. The authors provide thorough descriptions of high-quality breast cancer care, define targets, methods to assess one’s care, and ideas on how to improve care within one’s resources. A global view of the quality of breast cancer care shows specific best practices applicable to many centres operating in various health care systems with different financial and political situations. Foundation hallmarks of innovation, communication, patient-centred care, multidisciplinary, and budget considerations guide specific recommendations for each component of care. This book discusses global and local considerations so that optimally ‘integrated’ breast cancer care can be organized. Each component of care (e.g. imaging, surgery, etc.) is discussed from both theoretical and practical aspects. The recommendation for each component of care is facilitated by experienced experts laying out rational and practical approaches to each step. This book provides guidance how to integrate the different disciplines into breast cancer care. Beyond treatment, it provides practical considerations regarding accreditation and certification, and it comments on the influence of budget and of treatment. Finally, it demonstrates how best practices may be altered by the emerging involvement of patients, technologies, and transitions of future societal values.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

Acute inpatient mental health care remains an irreplaceable part of some people’s mental health recovery pathway, either through the severity of their difficulties or the associated risks. It can often be a traumatic experience associated with distress and vulnerability both for patients and their relatives. Modern acute inpatient psychiatric care must undoubtedly be truly multidisciplinary and part of a wider community-based system. It must emphasize dignity, compassion, and well-being as well as addressing challenges such as involuntary admissions, cultural diversity, physical comorbidities, and the needs of relatives, just to name a few. The present textbook focuses on these and related issues in a way that is relevant to frontline clinicians dealing with them daily, with medical, nursing, and legal aspects going hand in hand with topics such as team leadership or multidisciplinary work. The textbook describes inpatient services as provided in England, so it describes work that takes place within a national health service free at the point of delivery, carried out by universal primary care as well as secondary mental health care services, both operating within clinical governance structures that seek quality improvement and accountability. Crucially, both the Mental Health Act and the Mental Capacity Act provide unique legal frameworks for the care of mental ill health. The editors hope that for readers in the UK and beyond, the textbook will provide a real-life system which can be questioned and problematized and, in that way, may help to orient clinical work.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