Harplands Hospital

Positive behaviour support (PBS) is considered an effective and ethical approach to supporting people with learning disabilities who are at risk of behaviour that challenges. Many people with learning disabilities are supported in the community by staff with varying levels of PBS skills and practice, and training is important to ensure PBS is used consistently. In 2019, a community learning disability team in Staffordshire, England, developed a PBS skills training programme and delivered it to 57 senior staff from 16 local community services. In an evaluation of the training programme, participants reported some improvements in their PBS knowledge and practice, as well as some benefits for service users, after the training. However, no follow-up data could be obtained from participants six months after the training. This article describes the training programme, reports the findings of its evaluation and discusses how the findings will inform a future PBS skills development project.

<h3>Introduction</h3> Huntington’s disease (HD) is an autosomal dominant neurodegenerative disease caused by polyglutamine repeat expansion in the Huntington ‘<i>htt’ </i>gene. HD is characterised by motor and cognitive impairment. Motor abnormalities: chorea and athetosis, deterioration in cognitive function, behavioural changes and a mood component are common symptoms in the presentation of HD. Clinical observation has shown that Huntington’s patients also experience extreme temperature variance during the course of the disease. <h3>Objective</h3> To perform a literature review into the possible causes of defective thermoregulation in HD and highlight recent scientific and clinical findings. <h3>Methods</h3> AMED, EMBASE, MEDLINE, PsycINFO, BNI,CINAHL databases were searched for relevant papers over the last 10 years. 14 were found but only 3 are directly related to thermoregulation in HD (murine studies, case reports) during this time frame and have been included in this review. <h3>Results</h3> Articles reviewed: D. Gassbeek, <i>et al</i>. Drug-induced hyperthermia in Huntington’s disease. <i>J Neurol</i>2004;251:454-457 Weydt P. <i>et al</i>., Thermoregulatory and metabolic defects in Huntington’s disease transgenic mice implicate PGC-1alpha in Huntington’s disease neurodegeneration. <i>Cell Metabolism</i>2006;4:349-362 DOI:10.1016/j.cmet.2006.10.004 Renoir T,<i>et al</i>. Sexually dimorphic serotonergic dysfunction in a mouse model of Huntington’s disease and depression. <i>PLoS One</i>2011;6(7):e22133 <h3>Discussion</h3> Using the parameters mentioned in the methods section we reviewed three papers concerning thermoregulation in HD over the last 10 years. It appears that information in this niche field is quite limited and experimentation is required to evolve our understanding of the pathogenesis of this fatal disease. The first article attempts to link the use of psychotropics in the treatment of psychotic symptoms of HD with hyperthermia. The second article explores the profound thermoregulatory defect in the BAT of HD transgenic mice. Multiple cohorts were tested for adaptative thermogenesis at week 10 and 20 of age with all the test subjects displaying significant reduction in body temperature during the cold challenge. The authors implicate transcriptional interference of PGC-1α in the murine HD BAT and postulate that mitochondrial dysfunction in HD may stem from ployQ-htt interference with PGC-1α in the nucleus linking transcriptional dysregulation with mitochondrial pathology in HD. They propose HD therefore to be a metabolic disease and that PGC-1α dysregulation affiliated with temperature fluctuations in HD. However, clinical observation yields an inconsistency in the symptoms experienced by patients as some experience hyperthermia and some hypothermia. So far the literature only shows drug induced hyperthermia in HD and murine models of hypothermia. We do not have a unifying concept nor an adequate amount of data and therefore it remains difficult to draw robust conclusions about the causes of temperature dysregulation in HD. This review highlights the need for further research in this area. Understanding thermoregulation in HD can potentially have great therapeutic value for some patients and would assist clinicians in developing a more robust management plan.

There have been increasing numbers of suggestions that general practitioners (GPs) should be more involved in undergraduate teaching. This study looks at GPs' opinions regarding those best placed to deliver undergraduate psychiatry teaching and what areas of the curriculum GPs feel competent to teach. The study aims to inform decisions about the contribution of GPs to the delivery of undergraduate teaching in psychiatry. A questionnaire asked GPs about teaching undergraduate psychiatry in both general and specialist areas. The response rate was 61%. Over a third of GPs felt competent to teach psychiatry to undergraduates in a general practice setting, and the vast majority thought psychiatry should be taught by a combination of GPs and psychiatrists. GPs felt least confident about teaching child psychiatry and addiction. Many GPs would like to be involved in teaching psychiatry and would welcome further training. The study suggests that there is capacity for increasing teaching in collaboration with GPs.

A recent report by the UK Drugs Policy Commission has highlighted the high levels of drug use in Britain and this has been interpreted as indicative of ineffective drug polices. However, the interpretation was based on sporadic self-report data and indirect extrapolation. This paper assesses trends in the prevalence and incidence of drug misuse in the UK from 1998 to 2005 as recorded in general practice. The study was a retrospective analysis of the General Practice Research Database. The study cohort comprised approximately 900,000 patients each year from 183 general practices. Among the Government's key target age group (16-24 years), there was a marked decrease in both prevalence and incidence of illicit drug misuse from 1998 to 2002 (P < 0.01). In older adults (25-59 years), the pattern was more variable during the first part of this period, but incidence remained stable from 2002 to 2005. These data indicate that the problematic drug use in the UK may be declining and that the policies may be more effective than has been previously thought. General Practice data are nonetheless only part of the picture in terms of understanding the prevalence of problematic drug use.

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This article considers the results of a retrospective study comparing pregnancy rates in one Drug Testing and Treatment Order (DTTO) service in the United Kingdom with pregnancy rates in a generic substance misuse service and national conception rates. Conception rates were found to be six times higher in the coerced drug treatment group compared to the general population and generic drug services over the same period. These higher pregnancy rates may possibly be accounted for by an interplay of several factors including improved physical health, improvements in menstrual cycle regularity, better social interactions or intrinsic nature of the treatment regime in the clinics. The results of the study have implications for the criminal justice, health and other services involved in the care of these patients.

Aims and MethodWe explored the views of consultant psychiatrists (trainers and non-trainers) on the effectiveness of the research day. We sent out postal questionnaires to consultant psychiatrists in general adult and old age psychiatry in the West Midlands to evaluate their own experience of the research day and how useful they felt it was.ResultsThe survey had a response rate of 72% (88 out of 122) and the majority of respondents had a positive view of their experience (31 trainers, 60%; 25 non-trainers, 69%). However, more consultant trainers (37, 71%) compared with non-trainers (15, 42%) felt that the research day in its current format should be modified.Clinical ImplicationsThe research day is useful for the training of specialist registrars and our study confirms this view from the consultants surveyed. Some improvement is required in order for specialist registrars to obtain optimal benefit. We make some suggestions for improving the day's effectiveness.

This is the second paper of two, which considers the development, use and evaluation of an integrated care pathway (ICP) for acute inpatient mental health care. This paper reports an evaluation that was carried out to measure the impact of an ICP (described in Part 1) on the interventions it was designed to guide. The methodology used was pre- and post-ICP comparison of activities/care recorded in health-care records using delineating measures. Data were gathered from the notes of 23 service-users who had two inpatient stays within a year, one pre-ICP and one post-ICP. The findings suggested an overall improved provision of interventions, although as the ICP progressed the likelihood of receiving interventions fell. Three specific aspects were not affected by the ICP, these were giving information about observation levels to service-users, care planning and medical interventions. These issues are discussed and the conclusion raise implications for further ICP development and implementation.

Historically, relationships with mental health professionals working in Russia have been difficult to sustain due to problems with access and perceived human rights infringements that existed earlier (Poloahij, 2001). This has resulted in many Russian psychiatric institutions having little opportunity to collaborate in international research or to take part in exchanges of information on service development. However, with the dissolution of the Soviet Union in 1991, Russia has been brought back into spheres of international cooperation in healthcare.