Maudsley Series – serie

There is a myth that people with mental disorders comply poorly with treatment. In fact, psychiatric patients are no more likely than patients in other medical specialities to go against the advice of their doctor. That said, it is easy to find instances where psychotropic medication is refused by the supposed beneficiary. The value of neuroleptic treatment in schizophrenia is now widely accepted. Failure to take such treatment is associated with relapse and relapse may endanger the patient and other people. Despite this, people with schizophrenia frequently fail to take their treatment. This study shows that one third can be expected to be non-compliant within two years of leaving a general adult psychiatry ward. It also looks at the reasons for this: the influence of drug side-effects is examined, as well as the impact of each patient's attitude to treatment and whether or not they have stopped taking prescribed medication in the past.

The concept of fitness to plead has its origins in the medieval courts of England, where the ritual of court proceedings demanded that accused individuals respond to the charges against them. Being fit to plead, however, has involved into a fundamental principle of British law and those legal systems that have evolved from it, and it is now associated with the principle of a fair trial. But in spite of its long heritage, the meaning of "being fit to plead", its implications and its consequences all remain vague. Little research has taken place in relation to the concept or its applications in England and Wales, and much of what has been said about fitness to plead has taken place in a factual vacuum.; This book is the result of extensive research into both the development of the concept of fitness to plead and its application. It is based on a review of all individuals found unfit in England and Wales between 1976 and 1988 and provides detailed information about those found unfit to plead and the circumstances associated with their findings, together with follow-up of the psychiatric and legal outcomes. Problems with the working of the law in relation to fitness to plead are discussed and recent changes to it are critically reviewed. The end result is a full consideration of whether the modern concept of fitness to plead protects individuals from unfair trials, and the courts from miscarriages of justice.

The incidence of aggression and violence is of wide concern. It is therefore vital that we try to understand the mechanisms involved. This book outlines definitions and theories of aggressive behaviour and points out the contribution of both biological and psychological factors. Aggression primarily occurs within an interpersonal exchange and is often accompanied by increased arousal and negative feelings. It is most likely to occur in response to provocation but individuals differ in what they consider constitutes provocation. Aggressive behaviour is both multicausal and multifaceted but in order to study it, we have to break it down into components and find ways in which to measure these.This book describes a body of research examining the conditions under which the behavioural, affective and physiological components of aggression are elicited. A specific experimental technique which measures behavioural aggression in the laboratory is described. The task was found to be sensitive to individual differences in aggressive disposition. Aggression is not, however, confined to a small group of extremely hostile individuals. Alcohol or substance abuse is often associated with aggression in the general population. The results of some studies examining the effects of alcohol and benzodiazepines on the feelings and behaviour of healthy volunteers are reported. The way in which people appraise a situation influences the way they feel and behave. These drugs, therefore, impair the ability to process socially relevant information which, in turn, lowers the threshold at which aggressive behaviour is likely to occur. It is only by continuing to study the complex interaction between pharmacological and psychological factors that we will gain more insight into the processes underlying aggressive behaviour.

The "epigenetic puzzle" which is schizophrenia, forms the focus of this Monograph, But The Authors Do Not Sit Comfortably With The Notion That this is an entity. Rather, they approach the non-affective psychoses on a broad epidemiological base, ascertaining cases of so-called "functional" psychoses over a quarter of a century. They examine admission policies, showing that patients are admitted to hospital on the grounds of their particular presentation, rather than their diagnosis. They explore Differences Between Males And Females With Psychotic Disorders, And Show that gender is a more powerful influence than diagnosis. They investigate trends over time, and find that demography is the major influence. Looking at criminality, they show that the factors predicting criminal Behaviour In Individuals With Psychotic Illness Are Much The Same In those without psychotic illness. And they trace the longitudinal course of illness, putting paid to the schizophrenia/manic depression dichotomy.; This monograph is an overview of the ideas and many of the findings generated by a highly productive group of researchers. It has a good chance to become one of the standard references in several of the key aspects of schizophrenia.

The influence of culture on mental illness has been the subject of considerable academic investigation and debate in recent years. This debate has provoked concerns about the validity and reliability of older methodologies which emphasised either universal characteristics of disorders which were heavily biased towards Euro-American systems, or the culturally relativist approach which saw psychological disorders as products largely of their own culture. The "new" cross-cultural psychiatry proposed that the integration of ethnographic and epidemiological techniques be required to enable a culture sensitive psychiatric model to emerge. This monograph describes a series of research studies conducted in primary care in Harare, Zimbabwe, focusing on the most frequent of all psychological disorders, Common Mental Disorders (CMD). The four consecutive studies are unique in several respects, most notably, the involvement of both biomedical and traditional health care providers at all stages, the development of an indigenous measure of CMD for use in epidemiological investigations, the examination of the relationship between local and biomedical models of psychological disorder and the sociodemographic and economic risk factors for CMD. The experiences and findings of these studies provide new directions in our understanding of the contribution of culture to the presentation, assessment, classification and risk factors for CMD in primary care in an urban African setting. The methodology used also sets out a model for epidemiological research in other areas of mental health in different cultural settings.

Across the world, cities are becoming larger, as populations drift from the country into urban areas. At the same time, the mentally ill are leaving the mental hospitals and new forms of care are being found in the community. The best ways in which services for the mentally ill can be organized in the community is still a matter for debate, and as cities become larger problems may become greater.; This text compares mental health services in London with those in Amsterdam, Baltimore, Bangalore, Copenhagen, Kobe, Madison, Porto Alegre, Sydney, Teheran and Verona. It describes arrangements that work in practice, and includes some of the ideas and practices in mental health services.

The authors offer cogent reviews of the literature pertaining to the formation and maintenance of delusions, but the most substantial parts of the monograph expound the empirical inquiries which they and their colleagues have carried out in recent years. Most of the research has been published elsewhere, but such is the relevance of the experiments cited to the whole schema that the monograph has unique value. It is a synthesis which portrays the contribution to date of cognitive science to the biology and psychopathology of delusional thinking, and convincingly demonstrates that this way of looking at things has a considerable future. There are important implications for therapy as well as for hypothesis formulation. The monograph is attractively written, and the authors present their claims with exemplary modesty. The whole tenor of their approach gives weight to the conviction that here we have a story that must be taken seriously. It is a significant book, and I warmly commend it to all those with an interest in the future of psychopathology, and especially to psychiatrists who wish to advance their understanding of mental states and avoid stagnating with outworn dogma." - Robert Cawley, University of London in British Journal of Psychiatry Delusions are a key symptom of psychosis and yet there is no single book which considers delusions from a psychological perspective. In part this is because the syndrome of schizophrenia has captured the attention of many workers, and in part because delusions, as private mental phenomena, are not well suited to purely behavioural or observational methods of enquiry. For the past two decades, however, cognitive psychology has been in its ascendancy and delusions, as beliefs, are particularly amenable to investigation applying cognitive concepts and methods. Within this framework, it is possible to consider continuities between delusional and ordinary beliefs, as well as to seek to identify differences. This book, therefore, uniquely presents a psychological model of delusions, employing the neglected strategy of single symptom research and the tools of cognitive psychology

Schizophrenia is a unique project reflecting the contribution that Robin M. Murray has made to the field of psychiatry over the past 35 years, with a particular focus on the advances that have been made to the understanding and treatment of schizophrenia.International contributors have been brought together to pay tribute to Robin Murray’s work and explore the latest findings in the area. Sections cover:neurodevelopment neuroscience and pharmacologyneuroimaginggeneticscognitionsocial psychiatrytreatment.This book will be essential reading for psychiatrists, clinical psychologists, social and basic scientists whose work is related to major mental illness, as well as admirers of the work of Robin Murray.

Early clinical intervention in psychosis is now a major objective of mental health services and the development of specialist intervention services has greatly facilitated research on the early phases of this disorder.In this book, contributors provide a review of the neurobiological research in people at high risk of psychosis, focusing on the transition from being at a high risk state to their first episode. Contributors consider unaffected family members and twin studies as well as the individual’s data before and after the onset of the illness. The environmental factors that contribute to a psychotic episode are also examined.Vulnerability to Psychosis presents neurobiological findings in the context of what is now known about the psychopathology and cognitive impairments that are evident in people at high risk of psychosis. It will be essential reading for clinicians working with this client group, and will interest academics looking for state of the art information in this field.

The authors offer cogent reviews of the literature pertaining to the formation and maintenance of delusions, but the most substantial parts of the monograph expound the empirical inquiries which they and their colleagues have carried out in recent years. Most of the research has been published elsewhere, but such is the relevance of the experiments cited to the whole schema that the monograph has unique value. It is a synthesis which portrays the contribution to date of cognitive science to the biology and psychopathology of delusional thinking, and convincingly demonstrates that this way of looking at things has a considerable future. There are important implications for therapy as well as for hypothesis formulation. The monograph is attractively written, and the authors present their claims with exemplary modesty. The whole tenor of their approach gives weight to the conviction that here we have a story that must be taken seriously. It is a significant book, and I warmly commend it to all those with an interest in the future of psychopathology, and especially to psychiatrists who wish to advance their understanding of mental states and avoid stagnating with outworn dogma." - Robert Cawley, University of London in British Journal of Psychiatry Delusions are a key symptom of psychosis and yet there is no single book which considers delusions from a psychological perspective. In part this is because the syndrome of schizophrenia has captured the attention of many workers, and in part because delusions, as private mental phenomena, are not well suited to purely behavioural or observational methods of enquiry. For the past two decades, however, cognitive psychology has been in its ascendancy and delusions, as beliefs, are particularly amenable to investigation applying cognitive concepts and methods. Within this framework, it is possible to consider continuities between delusional and ordinary beliefs, as well as to seek to identify differences. This book, therefore, uniquely presents a psychological model of delusions, employing the neglected strategy of single symptom research and the tools of cognitive psychology

There is a myth that people with mental disorders comply poorly with treatment. In fact, psychiatric patients are no more likely than patients in other medical specialities to go against the advice of their doctor. That said, it is easy to find instances where psychotropic medication is refused by the supposed beneficiary. The value of neuroleptic treatment in schizophrenia is now widely accepted. Failure to take such treatment is associated with relapse and relapse may endanger the patient and other people. Despite this, people with schizophrenia frequently fail to take their treatment. This study shows that one third can be expected to be non-compliant within two years of leaving a general adult psychiatry ward. It also looks at the reasons for this: the influence of drug side-effects is examined, as well as the impact of each patient's attitude to treatment and whether or not they have stopped taking prescribed medication in the past.

The concept of fitness to plead has its origins in the medieval courts of England, where the ritual of court proceedings demanded that accused individuals respond to the charges against them. Being fit to plead, however, has involved into a fundamental principle of British law and those legal systems that have evolved from it, and it is now associated with the principle of a fair trial. But in spite of its long heritage, the meaning of "being fit to plead", its implications and its consequences all remain vague. Little research has taken place in relation to the concept or its applications in England and Wales, and much of what has been said about fitness to plead has taken place in a factual vacuum.; This book is the result of extensive research into both the development of the concept of fitness to plead and its application. It is based on a review of all individuals found unfit in England and Wales between 1976 and 1988 and provides detailed information about those found unfit to plead and the circumstances associated with their findings, together with follow-up of the psychiatric and legal outcomes. Problems with the working of the law in relation to fitness to plead are discussed and recent changes to it are critically reviewed. The end result is a full consideration of whether the modern concept of fitness to plead protects individuals from unfair trials, and the courts from miscarriages of justice.

The "epigenetic puzzle" which is schizophrenia, forms the focus of this Monograph, But The Authors Do Not Sit Comfortably With The Notion That this is an entity. Rather, they approach the non-affective psychoses on a broad epidemiological base, ascertaining cases of so-called "functional" psychoses over a quarter of a century. They examine admission policies, showing that patients are admitted to hospital on the grounds of their particular presentation, rather than their diagnosis. They explore Differences Between Males And Females With Psychotic Disorders, And Show that gender is a more powerful influence than diagnosis. They investigate trends over time, and find that demography is the major influence. Looking at criminality, they show that the factors predicting criminal Behaviour In Individuals With Psychotic Illness Are Much The Same In those without psychotic illness. And they trace the longitudinal course of illness, putting paid to the schizophrenia/manic depression dichotomy.; This monograph is an overview of the ideas and many of the findings generated by a highly productive group of researchers. It has a good chance to become one of the standard references in several of the key aspects of schizophrenia.

The influence of culture on mental illness has been the subject of considerable academic investigation and debate in recent years. This debate has provoked concerns about the validity and reliability of older methodologies which emphasised either universal characteristics of disorders which were heavily biased towards Euro-American systems, or the culturally relativist approach which saw psychological disorders as products largely of their own culture. The "new" cross-cultural psychiatry proposed that the integration of ethnographic and epidemiological techniques be required to enable a culture sensitive psychiatric model to emerge. This monograph describes a series of research studies conducted in primary care in Harare, Zimbabwe, focusing on the most frequent of all psychological disorders, Common Mental Disorders (CMD). The four consecutive studies are unique in several respects, most notably, the involvement of both biomedical and traditional health care providers at all stages, the development of an indigenous measure of CMD for use in epidemiological investigations, the examination of the relationship between local and biomedical models of psychological disorder and the sociodemographic and economic risk factors for CMD. The experiences and findings of these studies provide new directions in our understanding of the contribution of culture to the presentation, assessment, classification and risk factors for CMD in primary care in an urban African setting. The methodology used also sets out a model for epidemiological research in other areas of mental health in different cultural settings.

Mental illness causes a substantial health burden in all regions of the world, and is a major contributor to world poverty.Developing a National Mental Health Policy is designed to support those involved in developing locally appropriate mental health policies, emphasising the crucial role of primary care, NGOs, the social sector, schools and workplaces, and the criminal justice system as well as the specialist mental health services.The book addresses the principles of human rights, mental health legislation, mental health information systems, human resources, accountability and financing as well as key cultural issues. It gives a comprehensive and up to date account of the task of tailoring mental health services to the needs of countries in the post-institutional era.

Social inequalities are established features of the distribution of physical disease in the UK and many other developed countries. In most physical diseases, a clear trend of poorer health is evident with each step down the hierarchy of social position. By contrast, the nature of the links between social position and mental illness in the general population has appeared less clear. This lack of clarity is problematic, as mental disorders are major causes of disability, especially in adults of working age. Social Inequalities and the Distribution of the Common Mental Disorders presents in-depth and up-to-date research, looking at the links between social position, ethnicity and mental health. Its findings will have implications for mental health professionals and policy makers.

Paranoia is the suspicion that other intend to cause you harm. It is a common experience in the general population, though often overlooked. In its most severe form, paranoia occurs as persecutory delusions. Paranoia, written by leading researchers in this field, is the first cognitive psychology book to have persecutory delusions as its focus. Scholarly, comprehensive and illustrated by clinical examples throughout, this study defines the phenomena in detail and analyses the content of persecutory delusions. It reviews previous psychological writings, explores the relationship between psychosis and neurosis, reports on innovative empirical studies with patients, and highlights future essential research directions. Paranoia outlines a new theoretical model of the formation and maintenance of persecutory delusions, providing an excellent guide to this important clinical topic. It will be of great interest and use to all psychiatrists and clinical psychologists who work in this field.

The application of psychiatry to war and terrorism is highly topical and a source of intense media interest. Shell Shock to PTSD explores the central issues involved in maintaining the mental health of the armed forces and treating those who succumb to the intense stress of combat.Drawing on historical records, recent findings and interviews with veterans and psychiatrists, Edgar Jones and Simon Wessely present a comprehensive analysis of the evolution of military psychiatry. The psychological disorders suffered by servicemen and women from 1900 to the present are discussed and related to contemporary medical priorities and health concerns. This book provides a thought-provoking evaluation of the history and practice of military psychiatry, and places its findings in the context of advancing medical knowledge and the developing technology of warfare. It will be of interest to practicing military psychiatrists and those studying psychiatry, military history, war studies or medical history.

Hands-on Help is a narrative review of the mushrooming field of computer-aided psychotherapy for mental health problems as a whole, from the time it began in the 1960’s through to the present day. The many types of computer-aided psychotherapy and how each might be accessed are detailed together with the pros and cons of such help and the functions it can serve. The authors review prevention as well as treatment.The book describes and summarizes 97 computer-aided self-help systems in 175 studies according to the types of problem they aim to alleviate. These include phobic, panic, obsessive-compulsive and post-traumatic disorders, depression, anxiety, eating disorders, sexual problems, smoking, alcohol and drug misuse, schizophrenia, insomnia, pain and tinnitus distress, and childhood problems such as encopresis, autism and asthma. Within each type of problem the systems are described according to whether they are used on the internet, CD-ROM, phone, handheld or other device. The final chapter shows how internet self-help systems with phone or email support allow clinics to become more virtual than physical. It also discusses methods of screening suitability and of supporting users, constraints to delivery, uptake and completion, cost-effectiveness, and the place of computer-aided self-help in healthcare provision. This informative book will be essential reading for psychiatrists, psychologists and all other mental health professionals interested in broadening their understanding of computer-aided psychotherapy.

Attempted suicide is a matter of serious public health concern. Culture and Self-Harm considers the factors that may contribute to this increased rate of self-harm and suicide among south Asians in London, which cannot be blamed on migration alone. Cultural pressures that dictate the way stress is dealt with are examined and the effects of cultural conflict and changes in an individual's cultural identity are considered. Culture and Self-Harm offers a new preventative strategy that will be of theoretical and clinical interest to all mental health professionals, social workers, voluntary and primary care workers. It will help them understand significant factors that play a key role in the lives of south Asians who attempt suicide and what lessons can be learnt for dealing with other ethnic groups with the same problems.

This is the first book to investigate how mental illness is portrayed in Hindi cinema. It examines attitudes towards mental illness in Indian culture, how they are reflected in Hindi films, and how culture has influenced the portrayal of the psychoses.Dinesh Bhugra guides the reader through the history of Indian cinema, covering developments from the idealism of the 1950s to the stalking, jealousy and psychopathy that characterises the films of the 1990s. Critiques of individual films demonstrate the culture’s approach towards mental illness and reflect the impact of culture on films and vice versa. Subjects covered include:Cinema and emotionAttitudes towards mental illnessSocio-economic factors and cinema in IndiaIndian personality, villainy and historyPsychoanalysis in the films of the 60s.Mad Tales from Bollywood will be of interest to psychiatrists, mental health professionals, students of media and cultural studies and anyone with an interest in Indian culture.

The incidence of aggression and violence is of wide concern. It is therefore vital that we try to understand the mechanisms involved. This book outlines definitions and theories of aggressive behaviour and points out the contribution of both biological and psychological factors. Aggression primarily occurs within an interpersonal exchange and is often accompanied by increased arousal and negative feelings. It is most likely to occur in response to provocation but individuals differ in what they consider constitutes provocation. Aggressive behaviour is both multicausal and multifaceted but in order to study it, we have to break it down into components and find ways in which to measure these.This book describes a body of research examining the conditions under which the behavioural, affective and physiological components of aggression are elicited. A specific experimental technique which measures behavioural aggression in the laboratory is described. The task was found to be sensitive to individual differences in aggressive disposition. Aggression is not, however, confined to a small group of extremely hostile individuals. Alcohol or substance abuse is often associated with aggression in the general population. The results of some studies examining the effects of alcohol and benzodiazepines on the feelings and behaviour of healthy volunteers are reported. The way in which people appraise a situation influences the way they feel and behave. These drugs, therefore, impair the ability to process socially relevant information which, in turn, lowers the threshold at which aggressive behaviour is likely to occur. It is only by continuing to study the complex interaction between pharmacological and psychological factors that we will gain more insight into the processes underlying aggressive behaviour.

Across the world, cities are becoming larger, as populations drift from the country into urban areas. At the same time, the mentally ill are leaving the mental hospitals and new forms of care are being found in the community. The best ways in which services for the mentally ill can be organized in the community is still a matter for debate, and as cities become larger problems may become greater.; This text compares mental health services in London with those in Amsterdam, Baltimore, Bangalore, Copenhagen, Kobe, Madison, Porto Alegre, Sydney, Teheran and Verona. It describes arrangements that work in practice, and includes some of the ideas and practices in mental health services.

This book considers how mental health services have evolved over the past three decades to meet the needs of people with intellectual disability, focusing on the ways that theories and policies have been applied to clinical practice.Nick Bouras and Geraldine Holt both have extensive experience in developing and running mental health services and bring together international contributors all with longstanding expertise in the fields of mental health and intellectual disability. They present the current evidence-based practice on how people with intellectual disability can be best cared for in clinical settings. The book embraces a foreword by Professor David Goldberg and is divided into three sections: development of specialist mental health services, clinical practice, and training as an integrated component of service delivery.Chapters cover topics including:the association between psychopathology and intellectual disabilityinternational perspectivesneuroimaging and genetic syndromestraining professionals, families and support workers.Mental Health Services for Adults with Intellectual Disability provides an overview of the many improvements that have been made in services for people with intellectual disability, as well as examining the shortcomings of the services provided. It offers strategies and solutions for the wide array of interdisciplinary professionals who want to develop the range of resources on offer for people with intellectual disability.

Mental illness causes a substantial health burden in all regions of the world, and is a major contributor to world poverty.Developing a National Mental Health Policy is designed to support those involved in developing locally appropriate mental health policies, emphasising the crucial role of primary care, NGOs, the social sector, schools and workplaces, and the criminal justice system as well as the specialist mental health services.The book addresses the principles of human rights, mental health legislation, mental health information systems, human resources, accountability and financing as well as key cultural issues. It gives a comprehensive and up to date account of the task of tailoring mental health services to the needs of countries in the post-institutional era.

Social inequalities are established features of the distribution of physical disease in the UK and many other developed countries. In most physical diseases, a clear trend of poorer health is evident with each step down the hierarchy of social position. By contrast, the nature of the links between social position and mental illness in the general population has appeared less clear. This lack of clarity is problematic, as mental disorders are major causes of disability, especially in adults of working age. Social Inequalities and the Distribution of the Common Mental Disorders presents in-depth and up-to-date research, looking at the links between social position, ethnicity and mental health. Its findings will have implications for mental health professionals and policy makers.

Attempted suicide is a matter of serious public health concern. Culture and Self-Harm considers the factors that may contribute to this increased rate of self-harm and suicide among south Asians in London, which cannot be blamed on migration alone. Cultural pressures that dictate the way stress is dealt with are examined and the effects of cultural conflict and changes in an individual's cultural identity are considered. Culture and Self-Harm offers a new preventative strategy that will be of theoretical and clinical interest to all mental health professionals, social workers, voluntary and primary care workers. It will help them understand significant factors that play a key role in the lives of south Asians who attempt suicide and what lessons can be learnt for dealing with other ethnic groups with the same problems.

Paranoia is the suspicion that other intend to cause you harm. It is a common experience in the general population, though often overlooked. In its most severe form, paranoia occurs as persecutory delusions. Paranoia, written by leading researchers in this field, is the first cognitive psychology book to have persecutory delusions as its focus. Scholarly, comprehensive and illustrated by clinical examples throughout, this study defines the phenomena in detail and analyses the content of persecutory delusions. It reviews previous psychological writings, explores the relationship between psychosis and neurosis, reports on innovative empirical studies with patients, and highlights future essential research directions. Paranoia outlines a new theoretical model of the formation and maintenance of persecutory delusions, providing an excellent guide to this important clinical topic. It will be of great interest and use to all psychiatrists and clinical psychologists who work in this field.

The application of psychiatry to war and terrorism is highly topical and a source of intense media interest. Shell Shock to PTSD explores the central issues involved in maintaining the mental health of the armed forces and treating those who succumb to the intense stress of combat.Drawing on historical records, recent findings and interviews with veterans and psychiatrists, Edgar Jones and Simon Wessely present a comprehensive analysis of the evolution of military psychiatry. The psychological disorders suffered by servicemen and women from 1900 to the present are discussed and related to contemporary medical priorities and health concerns. This book provides a thought-provoking evaluation of the history and practice of military psychiatry, and places its findings in the context of advancing medical knowledge and the developing technology of warfare. It will be of interest to practicing military psychiatrists and those studying psychiatry, military history, war studies or medical history.