AIMS AND METHOD:Radically open dialectical behaviour therapy (RO DBT) is a transdiagnostic treatment designed to address disorders associated with overcontrol, including autism spectrum disorders (ASD). To date, no studies have reported on the effectiveness of RO DBT for people with ASD. Forty-eight patients were referred to a RO DBT programme, of whom 23 had a diagnosis of ASD. Outcome was measured using the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE) and the Questionnaire about the Process of Recovery. RESULTS:The intervention was effective, with a medium effect size of 0.53 for improvement in CORE global distress. End-point CORE global distress score was predicted from initial severity and a diagnosis of ASD. Participants with a diagnosis of ASD who completed the therapy had significantly better outcomes than completing participants without an ASD diagnosis. CLINICAL IMPLICATIONS:These findings provide preliminary support for RO DBT as an effective intervention for ASD in routine settings.

Background The lack of diversity in healthcare leadership has been reported as a risk factor for the impact of the COVID-19 pandemic on black and ethnic minority healthcare staff. The medical workforce is increasingly diverse but not necessarily in its senior leadership. Methods We aimed to describe the characteristics of psychiatrists with board-level responsibility in Mental Health Trusts in England, comparing the current picture to that of 2016, using publicly available sources of data. We examined whether the psychiatric leaders were representative of the consultant workforce. Results Psychiatrists in senior leadership positions are unrepresentative of the consultant workforce, with UK and Irish graduates, and forensic psychiatrists being over-represented, and general adult psychiatrists being under-represented. There has been minimal change between 2016 and 2020, despite a 50% turnover in those holding board-level responsibility. Conclusions If greater diversity in psychiatric leadership is desired, stronger action needs to be taken to promote leadership development opportunities from under-represented groups.

OBJECTIVES:The proportion of junior doctors required to complete psychiatry placements in the UK has increased, due in part to vacant training posts and psychiatry career workforce shortages, as can be seen across the world. The aim of this study was to understand the lived experience of a Foundation Year 1 junior doctor psychiatry placement and to understand how job components influence attitudes.DESIGN:The study was conducted using a cross-sectional qualitative phenomenological approach.SETTING:Hospital and community psychiatry department settings in the North East of England, UK.PARTICIPANTS:In total, 14 Foundation Year 1 junior doctors were interviewed including seven men and seven women aged between 23 and 34 years. The majority had completed their medical degree in the UK and were White British.RESULTS:The lived experience of a junior doctor psychiatry placement was understood by three core themes: exposure to patient recovery, connectedness with others in the healthcare team and subjective interpretations of psychiatry. The experiences were moderated by instances of role definition, reaction to the specialty and the organisational fit of the junior doctor capacity in the specialty.CONCLUSIONS:The study reinforces and adds to the literature by identifying connectedness as being important for both job satisfaction and morale, which is currently damaged within the junior doctor population. The study provides in-depth insights into the lived experience of psychiatry placements and can be taken forward by educationalists to ensure the placements are meaningful experiences for junior doctors by developing role definition, belonging, structure and psychiatric care responsibility.

Aims and method Summer schools are advocated as part of the national recruitment initiative despite little evidence of their impact. This study evaluates the effectiveness of a 3-day non-clinical initiative. Change in attitudes and career intention were measured by administering a questionnaire, which included the 30-item Attitudes Toward Psychiatry (ATP-30) survey, at the start and end of the event. Results Mean ATP-30 scores increased from 119 to 128, which represented a highly statistically significant change ( t = 5.40, d.f. = 18, P < 0.001). A positive shift in intention to pursue psychiatry as a career was demonstrated. Clinical implications These results suggest well-planned summer schools can have a significant impact on students' attitudes. Despite high initial ATP-30 scores a positive shift in attitudes and career intentions was still seen. Further evaluation of the longitudinal impact is needed. Events such as this are important and likely produce a cumulative effect alongside other recruitment strategies.

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BACKGROUNDBased on data from large multicentre US trials, the National Institute for Health and Clinical Excellence (NICE) is advocating a stepped-care model for the management of depression, with 'case management' or 'collaborative care' for selected patients in primary care.AIMTo conduct a pilot study examining the use of graduate mental health workers case managing depressed primary care NHS patients.DESIGN OF STUDYA randomised controlled trial comparing usual GP care with or without case management over 16 weeks of acute antidepressant drug treatment.SETTINGThree primary care practices in the North East of England.METHODPatients with depression, aged 18-65 years, who had failed to adequately respond to antidepressant treatment, were randomised to the two treatments. Assessments were made at baseline, 12, and 24 weeks using a combination of observer and self ratings.RESULTSRandomisation of 62 patients required screening of 1073 potential patients. There was little difference in outcome between the two treatment arms but a gradual improvement in symptoms over time was seen. Client satisfaction was assessed as high across both treatments.CONCLUSIONWhile this pilot study confirmed the integrity of the study protocol and the suitability of the outcome measures and randomisation procedure, it raises questions regarding the practicality of recruitment and feasibility of the intervention. It would be crucial to address these issues prior to the implementation of a large multi-centre randomised controlled trial.

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We examined beliefs about depression in patients and their partners and explored the impact of beliefs on perceptions of marital functioning, level of distress and caregiving in partners, and clinical outcome of major depression. Fifteen patients meeting criteria for major depressive disorder and their co-habiting spouses were interviewed at baseline using the Reasons for Depression Questionnaire (Addis, Truax and Jacobson, 1995) and measures of symptom severity, distress, caregiver consequences and marital satisfaction. Outcome was assessed at 6 months. Identifying biological reasons for depression was significantly associated with patient severity of depression and with caregiver burden. Caregiver distress was significantly associated with endorsement of interpersonal reasons for depression. Concordance in reason giving between patients and partners was significantly associated with a good outcome. This is the first study to show that beliefs about depression held by patients and their partners may have an impact on the clinical outcome of major depression.

Background. Although there is good evidence that cognitive therapy (CBT) lessens relapse and recurrence in unipolar depression, the duration of this effect is not known.Method. One hundred and fifty-eight subjects, from a randomized controlled trial of CBT plus medication and clinical management versus medication and clinical management alone, were followed 6 years after randomization (41/2 years after completion of CBT) and the longitudinal course assessed.Results. Effects in prevention of relapse and recurrence were found to persist, with weakening, and were not fully lost until 31/2 years after the end of CBT. Residual symptoms were also lessened.Conclusions. The effect of CBT in reduction of relapse and recurrence persists for several years. The potential value of subsequent additional CBT some time after cessation should be explored.

Priebe et al ([2003][1]) have questioned whether the findings of the Pan-London Assertive Outreach Study can be generalised to assertive outreach services in the rest of the UK. Cornwall & Haveman ([2003][2]) evaluated the Newcastle and North Tyneside assertive outreach service using the same

Editor—The authors of either of the two large trials of St John's wort for treating depression published in the BMJ have reported the proportion of patients entering full remission of symptoms after acute treatment.1,2 This is unfortunate as remission of symptoms rather than response to treatment should be the key outcome objective. Partial remission is a common adverse outcome of depression after short term treatment and carries with it a high risk of relapse and continuing disability.3 There is now emerging evidence that although all antidepressants seem to be similarly efficacious in producing a short term response, there are differences in remission rates, particularly in severely ill patients.4 This shows the importance of reporting categorical as well as continuous outcomes in clinical trials of treatment with antidepressants.

Background: The aim of the study was to evaluate the changes in the operation of a community mental health service five years after the implementation of the Care Programme Approach. Method: We undertook cross-sectional surveys in 1992, before the introductions of the CPA, and in 1998, to describe the case mix and service provided. The service is entirely community-based and attempts to reduce the use of in-patient facilities by early intervention, assertive outreach and partial hospitalisation. Results: The number of patients in contact with the service increased from 293 to 334 with an increased proportion with severe mental disorder (psychotic and mood disorders) but hospitalisation did not increase. Full multidisciplinary CPA was used for patients with severe disorders and low levels of functioning. Conclusion: Introduction of clinical case management through the care programme approach was associated with an increasing focus on patients with the most severe disorders.

Aims and MethodThe use of the Royal College of Psychiatrists' trainee's log book was evaluated by a cross-sectional survey of psychiatric trainees and their consultant trainers.ResultsOne-quarter of trainees had not received a log book. There was a lack of mutual commitment to using the log book, with fewer than 45% of trainees believing their trainers were committed to its use. There had been little use of the log book beyond the setting of educational objectives. However, concern that trainees would be against using the log book for formative assessment was not observed.Clinical ImplicationsMore work needs to be done by the College to promote the use of the log book to both trainees and trainers.

BACKGROUND:Many policy and research documents on the treatment of depression in primary care suggest that general practitioners (GPs) should make use of clinical guidelines.AIM:To describe the content of peer-reviewed guidelines for the detection and treatment of depression in primary care and help GPs identify the one most useful to their own needs.METHOD:Guidelines were evaluated by an explicit method using the Institute of Medicine assessment instrument and according to six key clinical management questions identified as important by GPs and psychiatrists.RESULTS:Only five (30%) of the published guidelines identified met all the pre-defined inclusion criteria. Total scores for development process and content ranged from 54% to 82%. Validity scores ranged from 52% to 88%. No guideline answered all the key questions identified by clinicians.CONCLUSIONS:Only two guidelines conform to the quality standard of a clinical practice guideline. One covers all aspects of detection and management of depression in primary care but gives no advice on first-line choice of antidepressant, while the other focuses only on medication and fails to explore problems of case detection or to consider non-pharmacological treatments. However, taken together they do cover most of the key clinical issues in a reliable and valid manner. The identified guidelines vary considerably in both utility and clinical applicability.

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