Clinical Skills in Psychiatric Treatment (Cambridge Clinical Guides)

"Effective and capable clinicians need to develop strong interpersonal, intellectual and organisational abilities. This practical and accessible text explores clinical skills that are increasingly assessed in training, postgraduate examinations, continuing professional development programmes and reaccreditation appraisals. It is concerned with balancing the demands of the patient's life circumstances with lessons from empirical science and clinical experience." "These skills help clinicians to put interventions together into effective treatment plans, and to develop strategies that facilitate recovery from mental illness. This book is written from a multidisciplinary perspective and it explores new ways of working. Although it is primarily addressed to psychiatrists, it is relevant to mental health nurses, social workers, occupational therapists and clinical psychologists."--BOOK JACKET Cover......Page 1 Half-title......Page 3 Title......Page 5 Copyright......Page 6 Contents......Page 9 Acknowledgments......Page 11 Robert Higgo......Page 13 Introduction......Page 15 Part I – Underlying principles......Page 19 1 Starting points......Page 21 Main points in this chapter......Page 26 The triangle of forces......Page 27 Scientific evidence......Page 28 Clinical experience......Page 30 Context......Page 32 Balancing the forces......Page 33 Main points in this chapter......Page 34 What is psychiatric treatment for?......Page 35 Rehabilitation and recovery......Page 38 Who benefits from psychiatric treatment?......Page 40 Main points in this chapter......Page 43 4 Strategic treatment......Page 44 A commonplace clinical scenario......Page 45 A reactive approach to the situation......Page 46 A strategic approach......Page 47 Forming a shared understanding of the nature of the problem......Page 48 Clarity over the objectives and limitations of treatment......Page 49 Prioritising problems, sharing the overall plan and proceeding in a stepwise fashion......Page 50 Anticipating and evaluating setbacks, and deciding whether to change the plan......Page 51 Maintaining realistic therapeutic optimism......Page 53 Recording strategic plans......Page 54 Main points in this chapter......Page 55 Part II – The context and location of treatment......Page 57 Who is a part of the team?......Page 59 Who does the team belong to?......Page 61 Leadership......Page 64 Effective teams......Page 65 Generic teams or specialist teams?......Page 66 Seeking advice from outside of the team......Page 68 Main points in this chapter......Page 69 Joint working......Page 70 Consultation......Page 72 Interfaces......Page 73 Boundary disputes......Page 75 Liaising with external agencies......Page 76 Team building......Page 77 Responsibility......Page 78 Group dynamics......Page 79 Awestruck teams......Page 80 Main points in this chapter......Page 81 Control......Page 82 Intensive treatment......Page 84 Inpatient units as therapeutic environments......Page 85 The course of inpatient episodes......Page 87 Integration of inpatient and community treatment......Page 88 Inappropriate and overextended admissions......Page 91 Main points in this chapter......Page 94 8 Compulsion and locked doors......Page 95 Long-term detention......Page 96 Locked doors......Page 99 At the end of the day, we have to live with it......Page 100 Main points in this chapter......Page 101 Outpatient clinics......Page 102 The strange rise and fall of the day hospital......Page 107 Treating people in unusual settings......Page 108 Main points in this chapter......Page 109 10 Models of care......Page 111 Mental capacity......Page 114 Mental capacity as a clinical concept......Page 116 Insight and responsibility......Page 117 Mentally disordered offenders......Page 118 Is holistic care necessarily a good thing?......Page 120 Main points in this chapter......Page 121 Part III – Problems in treatment......Page 123 11 Engagement......Page 125 Team engagement......Page 130 Difference......Page 131 Respect and dignity......Page 132 Main points in this chapter......Page 134 12 Compliance and concordance......Page 135 Why don’t patients do as they are told?......Page 136 ‘Non-compliance is not an option’......Page 138 Why do patients adhere to treatment plans?......Page 139 Side effects......Page 140 Depot antipsychotics......Page 143 Self-management strategies......Page 144 Specific interventions to achieve adherence......Page 145 The bottom line......Page 146 Main points in this chapter......Page 147 Factors associated with treatment resistance......Page 148 Two clinical problems and their resolution......Page 151 Developing a personal prescribing algorithm......Page 156 The role of the magical and dramatic in managing treatment resistance......Page 158 Nasty and forbidden treatments......Page 159 Intractably stuck......Page 160 Conclusion......Page 161 Main points in this chapter......Page 162 14 Complicated problems......Page 163 Substance misuse and psychosis......Page 164 Pregnancy and puerperium......Page 168 Late disclosure of painful secrets......Page 171 Main points in this chapter......Page 173 15 Managing risk......Page 175 Acute behavioural disturbance......Page 176 The principles of managing acute behavioural disturbance in hospital......Page 179 Acute disturbance that does not settle......Page 181 Chronic suicidality......Page 182 When the worst happens......Page 187 Main points in this chapter......Page 188 16 Staying well......Page 190 Long-term medication......Page 191 Bipolar affective disorder......Page 192 Schizophrenia......Page 193 Psychosocial interventions......Page 194 Personality factors......Page 196 Is recovery a realistic aim for everyone?......Page 200 Main points in this chapter......Page 202 Part IV – Coping......Page 203 17 Coping with dilemmas......Page 205 Personal idiosyncrasies......Page 206 Unethical policies......Page 207 Whom do ethics belong to?......Page 208 Difficult families......Page 210 Quick fixes......Page 211 Unacceptable choices......Page 212 Treating colleagues......Page 214 Is this the best we can do?......Page 215 Main points in this chapter......Page 216 18 Coping with change......Page 217 Routes to burn-out......Page 218 Physician heal thyself......Page 219 New treatments......Page 220 Emergent disorders......Page 222 Professional use of euphemisms and neologisms......Page 223 Main points in this chapter......Page 225 Afterword: Optimism of the will and pessimism of the intellect......Page 227 References......Page 231 Index......Page 235 This practical and accessible text is dedicated to teaching skills and new ways of working that are increasingly assessed in training, continuing professional development programmes, postgraduate examinations and reaccreditation appraisals. It is concerned with balancing the demands of the patient's life circumstances with lessons from science and clinical experience. Starting points A triangle of forces Treatment objectives Strategic treatment Teams Team work Inpatient treatment in the era of community psychiatry Compulsion and locked doors Not at home, not in hospital Models of care Engagement Compliance and concordance Treatment resistance Complicated problems Managing risk Staying well Coping with dilemmas Coping with change.