Deaf psychiatry: a review of the difficulties and the effect of an inquiry on current practice.

Communication is a huge difficulty in researching Deafness in psychiatry and in practically assessing and treating deaf patients. This paper aims to review the difficulties surrounding the assessment and treatment of deaf patients, using a review of the current literature on audio-visual hallucinations as an example. It will also include a summary of the published inquiry into the care and treatment of Daniel Joseph (a profoundly Deaf man), and a review of the Department of Health consultation document and NHS England responses to that inquiry as evidence of why these difficulties have relevance in everyday practice.

The use of Music Therapy in the treatment of Mental Illness and the enhancement of Societal Wellbeing.

Music Therapy can be broadly described as the use of Music in a therapeutic context in order to help improve mental health. Music Therapy does not simply imply the playing of music to patients, relaxing though this may be, but in fact it does involve more active involvement of the patient, so as to use the power of music in order to help improve the mental health of patients and in order to treat mental health conditions. We review the evidence for the effect of Music Therapy on Depression, Anxiety, Schizophrenia, Sleep Disorders, and Dementia.

The neuroscience of music; a review and summary.

Present knowledge about the neurobiology of music is discussed and summarised. Music playing, reading and listening are all complex processes requiring co-ordination of various parts of the brain in hierarchically structured sequences. The involvement of the right hemisphere of the brain in musical functions is well established, however in fact both hemispheres are involved.

Tertiary Syphilis (General Paralysis of the Insane) and Bipolar Disorder; the role of these two disorders in the life of famous composers.

Syphilis is a complex disease, which can lead to General Paralysis of the Insane if left untreated. Before antibiotics this was the natural progression of the disease, with many people being admitted to mental asylums with the diagnosis of GPI, and going on to die there. Diagnoses however, were difficult, as it was difficult to distinguish between GPI and other mental conditions such as bipolar disorder.

Does Schizoaffective Disorder explain the mental illnesses of Robert Schumann and Vincent Van Gogh?

The geniuses Robert Schumann and Vincent Van Gogh show striking similarities both in the longitudinal nature of the progression of their illnesses, and the symptoms they experienced. There have been physiological explanations posed for both men, including Meniere's disease, tertiary syphilis, acute intermittent porphyria, terpenoid and lead poisoning, intracranial masses, temporal lobe epilepsy and dementia caused by vascular hypertension. The evidence for these physiological explanations is assessed.

What is Beauty? Should Doctors point out Beauty to their patients during therapy?

It has been argued that aesthetics, or the appreciation of beauty, can be used in therapy. We explore this concept from the point of view of new findings in neurobiology which give us an understanding of the mechanisms by which we experience beauty and creativity. We argue from anthropological perspectives that the experience of beauty is common to all cultures, and leads to the experiencing of important abstract concepts which enhance our lives, but which may be described differently in different cultures.

The effect of music therapy sessions on the interactions between children and their parents and how to measure it, with reference to attachment theory.

Music therapy and attachment is an expanding field and the number of studies addressing the theoretical work is slowly growing. There are both qualitative and quantitative approaches to studying the effect of regular music therapy sessions on parent-child interactions and these cover a range of patient populations including: children at risk of neglect, parents with a trauma history, children coping with bereavement and a large number addressing the disability population, including autism spectrum disorder. These studies suggest that music therapy benefits the parent-child relationship through the improvement communication, especially non-verbal communication, and so increased the feeling of closeness and understanding.

Neuroscience and Visual Art; Moving through empathy to the Ineffable.

In this article we wish to discuss recent work on neurobiology and visual arts, with impact on human pleasure, wellbeing and improved mental health. We wish to discuss briefly our model of the Human Person and apply it to Visual Art, and we wish to discuss our view of how empathy has been suggested as an important factor in how visual art can impact the human person, with its links with neuroscience and anthropology, and thus how Visual Art can put Human Beings in touch with their deepest feelings and even with the ineffable.

Antidepressants in use in clinical practice.

The object of this paper, rather than producing new information, is to produce a useful vademecum for doctors prescribing antidepressants, with the information useful for their being prescribed. Antidepressants need to be seen as part of a package of treatment for the patient with depression which also includes psychological treatments and social interventions. Here the main Antidepressant groups, including the Selective Serotonin uptake inhibiters, the tricyclics and other classes are described, together with their mode of action, side effects, dosages.

The Use of the PHQ9 self-rating scale to assess depression within Primary Care.

The PHQ-9 is effective in screening patients for depressionas well as monitoring progress in a variety of situations. Using the PHQ-9 after a pre-assessment with the PHQ-2 increases its specificity, as well as preventing under-diagnosis. Although it is not suitable as a stand-alone tool for a diagnosis, it is a cost-effective, efficient method of screening patients in primary care.

Charity, Hospitality, and the Human Person.

We believe that in order to properly interpret all aspects of human scientific enquiry in terms of its impact on human beings it is necessary to have an adequate all encompassing model of the human person. We began this presentation by discussing the differences between the 'Cartesian' Dualistic model of the human Person and that of Aquinas and Augustine (which depend on Aristotle and Plato respectively). While the 'Cartesian' describes a completely separate 'soul' or 'mind' from the physical body, the Thomistic model of the Human Person is that of an Embodied Spirit, in which every aspect of the human spirit is reflected in an aspect or function of the physical body.

How does continuity of care affect quality of care in primary healthcare?

Continuity of care is generally considered beneficial in primary healthcare, and in this paper the evidence for such assumptions is examined. Studies and reviews showed that continuity of care is able to decrease unnecessary hospitalisation, length of hospital stay and attendance at Accident and Emergency departments, as well as improve patient and doctor experience. It has also been found that the continuity of care provided to patients varies greatly depending on patient demographic, GP surgery policy and size.

Do General Practitioners Follow Guidelines on the Use of Antidepressants To Treat Depression? Can the Situation Be Improved?

Several papers have been written to show that General Practitioners do not always prescribe according to the guidelines despite the availability of guidelines regarding the dosage and length of treatment with antidepressants to treat a depressive episode. Here we review the evidence as to whether GPs follow antidepressant guidelines, covering the data between 1996 and the present day, and discuss the implications of this evidence. We then propose solutions which could be used to improve adherence to the guidelines.

Is there good evidence that the two Questions in PHQ-2 are useful questions to use in order to screen for depression?

The PHQ-2 has been presented as an ultra-short screening questionnaire to detect depression in several healthcare settings. This paper will outline its current uses, evaluate its accuracy as a screening method, and suggest potential uses.

A Review of the Epidemiology of Major Depressive Disorder and of its consequences for Society and the individual.

Depression is a common and debilitating disease that affects people from adolescence to old age. The impact of depression extends beyond the individual with depressive symptoms. Depression adversely affects the mental and physical health, and the social and financial welfare of the individual and society.

Stigma in Malta; A Mediterranean Perspective.

The aim of this paper to describe what Transcultural Psychiatry is. It attempts to describe stigma in Malta and how it comes about that the Mental Hospital in Malta is named for Our Lady of Mount Carmel and finally attempt to put Mount Carmel Hospital and its dedication within Maltese Culture and the culture of the Mediterranean. The paper demonstrates that to understand this, it is necessary to employ History, Anthropology, Theology, among other issues.

Long-term trajectories of cognitive deficits in schizophrenia: A critical overview.

Background: Cognitive disturbances are widely pronounced in schizophrenia and schizophrenia spectrum disorders. Whilst cognitive deficits are well established in the prodromal phase and are known to deteriorate at the onset of schizophrenia, there is a certain discrepancy of findings regarding the cognitive alterations over the course of the illness.

Methods: We bring together the results of the longitudinal studies identified through PubMed which have covered more than 3 years follow-up and to reflect on the potential factors, such as sample characteristics and stage of the illness which may contribute to the various trajectories of cognitive changes.

Could Carmelite Spirituality Promote Good Mental Health? A brief Tribute to Saint Teresa of Avila in the 500th anniversary of her birth.

Often it is overlooked that Christian Spirituality involves a personal relationship of a human being with God. It is of interest that both the Protestant Reformers and the exponents of the Catholic Counter Reformation agreed upon this. Two of the greatest exponents of the Counter-Reformation, both of whom were made Doctors of the Church because of their teaching on Prayer were Saint Teresa of Avila and Saint John of the Cross.

The Concept of Body Language in the Medical Consultation.

In this paper we wish to argue that the human body is an instrument of communication that can be used by the individual. This can be shown by the use of phenomenology, as described by Husserl, and that indeed empathy, as described by phenomenology, can be seen as a link enabling two human bodies/persons to communicate. We then wish to show from neuroscience that empathy can itself be seen as a bodily function.

Classification in psychiatry: from a symptom based to a cause based model?

The assumption that eventually the classification in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) will incorporate aspects of causation uncovered by research in neuroscience is examined in view of the National Institute of Mental Health's NIMH Research Domain Criteria (RDoC) project. I argue that significant advantages of maintaining the classification system, focussed on grouped descriptions of symptoms, are often undervalued or not considered. In this paper I will challenge the standard view that the transition from the purely symptom based approach is an inevitable and desirable change.

The State of the Art of the DSM-5 "with Mixed Features" Specifier.

The new DSM-5 "with mixed features" specifier (MFS) has renewed the interest of the scientific community in mixed states, leading not only to new clinical studies but also to new criticisms of the current nosology. Consequently, in our paper we have reviewed the latest literature, trying to understand the reactions of psychiatrists to the new nosology and its epidemiological, prognostic, and clinical consequences. It seems that the most widespread major criticism is the exclusion from the DSM-5 MFS of overlapping symptoms (such as psychomotor agitation, irritability, and distractibility), with a consequent reduction in diagnostic power.

Petals: An Assessment of the Outcomes of a Service for Bereavement during Childbirth.

Objectives: We aimed to evaluate the outcomes of Petals: a charitable organisation in Cambridgeshire. Petals provides counselling for women and couples who have suffered perinatal bereavement, or trauma during pregnancy or birth. This paper attempts to evaluate the effect of counseling interventions at this difficult time.

The differences between typical and atypical antipsychotics: the effects on neurogenesis.

Recently, the pharmacological division between typical and atypical antipsychotics has been called into question. New evidence, however, continues to emerge showing differences between these two classes of drugs. Hence typical and atypical antipsychotics are clearly different classes of drugs, as evidenced by their actions, mechanisms, effects and side effects.

The issue of five year outcomes in early intervention in psychosis--consequences for the design of services.

Early intervention for psychosis services have been a very important area of development in Community Mental Health in recent years. Here we attempt to describe the general principles on which early intervention services are based, the interventions which such services carry out, and the expected outcomes according to the latest literature. While there is consensus that at 3 years after the first episode, outcomes from an ad hoc Early Intervention Team are better than treatment as usual in a Community Mental Health Team.