ABSTRACT
AIMS AND METHODS: All psychiatry trainees (both Basic and Higher Specialist Trainees in Adult and Old Age Psychiatry) in the Nottingham (Mid-Trent rotation) were invited to complete a questionnaire evaluating the assessment and training of psychosexual and relationship problems in the general mental health services. RESULTS: Only 24% of trainees reported to routinely asked patients about psychosexual history, 65% felt comfortable about taking a detailed psychosexual history. 81% of trainees reported inadequacy whilst dealing with psychosexual disorders during their training in psychiatry. Only 30% reported asking patients for potential sexual side-effects when on psychotropic medication. All the trainees would refer the patient to a local psychosexual disorder clinic (if available). CLINICAL IMPLICATIONS: Taking a sexual and relationship (both past and current) history should be an integral part of any psychiatric assessment. Training in human sexuality should be introduced in medical schools. Training in human sexuality is a core part of psychiatric training curriculum and trainees should be tested for their competency in dealing with sexual dysfunctions.
Subject(s)
Clinical Competence/standards , Education, Medical, Undergraduate/standards , Medical History Taking/standards , Mental Health Services/standards , Psychiatry/education , Sex Counseling/education , Education, Medical, Undergraduate/methods , Educational Measurement , Health Surveys , Humans , Interpersonal Relations , Sexual Dysfunctions, Psychological/therapy , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To describe the development and validation of the Clinical Global Impression-Schizophrenia (CGI-SCH) scale, designed to assess positive, negative, depressive and cognitive symptoms in schizophrenia. METHOD: The CGI-SCH scale was adapted from the CGI scale. Concurrent validity and sensitivity to change were assessed by comparison with the Positive and Negative Symptom Severity (PANSS) and Global Assessment of Functioning (GAF) scales. To evaluate inter-rater reliability, all patients were assessed by two clinicians. RESULTS: Symptoms were assessed in 114 patients. Correlation coefficients between the CGI-SCH and the GAF and PANSS scores were high (most above 0.75), and were highest for positive and negative symptoms. Reliability was substantial (intraclass correlation coefficient, ICC > 0.70) in all but one dimension (depressive dimension, ICC = 0.64). CONCLUSION: The CGI-SCH scale is a valid, reliable instrument to evaluate severity and treatment response in schizophrenia. Given its simplicity, brevity and clinical face validity, the scale is appropriate for use in observational studies and routine clinical practice.
Subject(s)
Psychiatric Status Rating Scales , Schizophrenia/physiopathology , Adult , Cognition Disorders/physiopathology , Depression/physiopathology , Female , Humans , Male , Middle Aged , Multicenter Studies as Topic , Observer Variation , Reproducibility of Results , Schizophrenic Psychology , Sensitivity and Specificity , Severity of Illness Index , Treatment OutcomeABSTRACT
Official guidelines for the practice of electroconvulsive therapy (ECT) recommend routine seizure modification to minimize musculoskeletal complications; nevertheless, unmodified ECT continues to be administered in India. We therefore assessed musculoskeletal morbidity with unmodified ECT with particular reference to the development of vertebral fractures and backache X-rays of the thoracolumbar spine were routinely obtained before and after a course of 6 ECTs in 50 consecutive schizophrenic patients receiving unmodified sinusoidal wave treatment.Backache was reported by 52% of patients; the symptom was severe in 14%. Severe backache developed early during the ECT course and was commoner in older patients. Gender, height and weight did not predict either presence or severity of backache. One patient experienced a vertebral fracture which was not considered serious this contrasts with the 20-40% incidence of adverse orthopedic events described with unmodified ECT in early studies. There were no other untoward events. It is concluded that, with specific reference to Indian patients, musculoskeletal morbidity with unmodified ECT may be less than earlier believed Risks with modified vs unmodified ECT therefore need to be systematically reassessed, and decision-making processes may need to be reformulated taking individual situations into account. The findings, conclusions and recommendations of this study carry much medicolegal significance for practitioners of ECT in India.
