Articles for tag: diagnosis, medication, prescribing, psychiatry, schizophrenia, treatment, treatment-resistant schizophrenia

Schizophrenia and TRS

February 5, 2025October 12, 2024 by TheEditor

Schizophrenia is a widely understood and misunderstood mental health condition. Many mental health professionals believe they ‘know’ what schizophrenia is. Ideas ‘about delusions and hallucinations’ just scratch the surface, as will be seen when ICD-11 criteria are explored. While the publisher and author(s) have used their best efforts in preparing information at this website, they …

Core list of key standards and knowledge

February 5, 2025September 4, 2024 by TheEditor

Standards is a big issue in medical practice. Standards therefore apply in psychiatry as a medical discipline. Psychiatrists are medical doctors; *not psychologists. This article is an aggregate of the key standards the author uses regularly, and visits about once per week. This was originally in a MS Word document. Now it is here for …

Paragraph 98 and remote consultations

February 5, 2025March 1, 2024 by TheEditor

This blog has considered a number of issues relevant to prescribing of medications. Paragraph 98 is one of the most powerful. It is squarely designed to protect patients. You are responsible for any prescription you sign, including repeat prescriptions for medicines initiated by colleagues, so you must make sure that any repeat prescription you sign …

Prescribing scenarios and the power of medications

February 23, 2025August 18, 2023 by TheEditor

In this post I will spend some time understanding the power of medications, then extract some fundamental principles from the GMC’s guidance on prescribing (April 2021). I then analyse two real-world scenarios in prescribing that I have experienced and reference each against the GMC’s guidance. [The scenarios do not contain information that identifies any patient. …

Sitting in the lap of Big Pharma

April 3, 2024July 22, 2023 by TheEditor

Following a recent BBC documentary on antidepressants(2023), I was set on a path of deeper inquiry about psychotropic medications and the relationship of Big Pharma to psychiatrists as a group. Then my colleague S.D. got me reading: The Empire of Pain: The Secret History of the Sackler Dynasty. I was driven to do some digging …

Hysteria, physician assisted paroxysms and sexual relations

April 11, 2024July 1, 2023 by TheEditor

This post is an off-shoot from Strange Medical Treatments in History. Introduction I began digging deeper into many of those treatments but then got stuck on what was termed ‘Physician Assisted Paroxysms‘ (PAP). I became totally flabbergasted by what I found. It would have been too much to add to that post, so I decided …

Polypharmacy

March 3, 2024May 29, 2023 by TheEditor

Polypharmacy is the use of multiple medications by a patient, particularly when too many forms of medication are used by a patient, when more medications are prescribed than are clinically warranted, or when all of an individual’s medications are not clinically necessary. While there is no set number of medications that defines polypharmacy, the term …

Off-label and off-licence prescribing

February 23, 2025May 3, 2023 by TheEditor

In the UK, the terms “off-label” and “off-licence” prescribing are often used interchangeably, but they refer to slightly different concepts. The General Medical Council wisely unified both concepts to the term ‘unlicenced prescribing’ . It does not mean ‘illegal prescribing’. Most unlicenced prescribing in the practice of medicine happens in psychiatry. Why is unlicenced prescribing …

Prescribing and related regulatory matters

July 10, 2024August 6, 2020 by TheEditor

The GMC’s standards on prescribing were updated in March 2022. This publication will have less weight and applicability. This article is intended to be of assistance: To medical doctors and other qualified persons undertaking or participating in medication reviews. To other staff who may be assisting doctors with arrangements for medication reviews. In understanding …

Stage	Cost/Price (£)	Tax/Duty (£)	Tax/Duty Type	Calculation	Calculation
1. Manufacturer’s Cost	2	0	N/A	This is a hypothetical cost of production.
2. Specific Duty Added	2	5.89	Specific Duty	£294.72 per 1000 cigarettes / 1000 * 20	Fixed amount per pack.
3. Manufacturer’s Profit	7.89	0	N/A	(Assumed to bring the total to £7.89)	This is a hypothetical profit margin.
4. Ad Valorem Duty Included	9	1.11	Ad Valorem Duty	16.5% of £9.00 (approx. retail price before VAT)	Included within the retail price, not added separately.
5. Retailer’s Profit	10.11	0	N/A	(Assumed to bring the total to £10.11)	This is a hypothetical profit margin.
6. Final Retail Price (excl VAT)	13	0	N/A	(Includes specific duty and ad valorem duty)	This is the price displayed on the shelf, excluding VAT.
7. VAT Added	13	2.6	Value Added Tax (VAT)	20% of £13.00	Applied at the point of sale.
Total	15.6	9.6	Approximately 61.5% of the final price (£15.60) is tax – due to the simplified conservative assumptions about manufacturer and retailer costs and profit margins.

Documentation Issue	Critique
Vague Descriptors	Terms like “distressed state,” “emptiness,” and “intense anger” lack specific behavioural anchors. The descriptions are mere observations without any real substance. How was the intensity of the anger manifested? What did the patient say? How did she appear? Was she grimacing? Without concrete examples, these descriptors are open to interpretation and do not provide a clear picture of the patient’s presentation.
Generalised Interventions	Phrases like “explored coping mechanisms” and “discussed strategies” are so general that they amount to padding. No one will know what specific coping mechanisms were explored. How did this worker actually attempt to help the patient? What exact strategies were discussed? How were these tailored to the patient’s individual needs and the nature of their emotional instability?
Lack of Measurable Outcomes	The record mentions the patient feeling “slightly calmer” but lacks objective measures to assess the effectiveness of the interventions. How was this improvement gauged? Is it just ‘your’ word for saying so? Many services will accept such records as ‘standard’ because of cultural norms.
Ambiguous Plan	The plan to “continue to work on developing skills” and “encourage the patient to practice techniques” is vague and lacks specific, measurable goals. What specific skills will be targeted? What techniques were discussed ‘between sessions’? How will progress be monitored? What constitutes “practice” in this context, and how will adherence be assessed?
Omission of Risk Assessment	Given the nature of EUPD and the potential for self-harm, the record should include a formal risk assessment. What specific risk factors were considered? How was the risk of self-harm evaluated and managed?
Limited Patient-Specific Insight	While the record mentions EUPD, it does not provide specific insights into how this diagnosis informs the interventions or the plan. How were the chosen strategies tailored to the patient’s unique challenges related to their personality disorder?

Cognitive Activity	Description
1. Information synthesis	Gathering and integrating diverse information; evaluating reliability and relevance of each piece
2. Evidence evaluation	Critically assessing quality and strength of available evidence; identifying gaps
3. Principle balancing	Weighing competing ethical principles; reconciling guidelines with case-specific considerations
4. Stakeholder consideration	Analysing individual patient needs/rights; considering regulatory and societal requirements
5. Consequence projection	Anticipating potential outcomes; assessing short-term and long-term consequences
6. Risk-benefit analysis	Systematically evaluating risks; weighing risks against potential benefits
7. Legal framework integration	Incorporating relevant legal standards; ensuring compliance with statutory obligations
8. Ethical reasoning	Applying ethical frameworks; resolving ethical dilemmas in forensic psychiatric practice
9. Interdisciplinary integration	Synthesising perspectives from various disciplines; reconciling conflicting viewpoints
10. Decision refinement	Iteratively reviewing and adjusting decisions; fine-tuning to address all relevant factors
11. Uncertainty management	Acknowledging areas of uncertainty; developing mitigation strategies
12. Prioritisation	Determining relative importance of factors; focusing on critical elements
13. Cognitive bias recognition	Identifying potential biases; implementing strategies to minimise their impact
14. Justification formulation	Developing clear, logical rationale; ensuring transparent and defensible reasoning
15. Contextual adaptation	Tailoring approach to specific case factors; recognising unique case influences

Schizophrenia and TRS

Core list of key standards and knowledge

Paragraph 98 and remote consultations

Prescribing scenarios and the power of medications

Sitting in the lap of Big Pharma

Hysteria, physician assisted paroxysms and sexual relations

Section 17 and other leave

Negligence in UK Law – Part 1

Beyond Cheshire West: A Triangular Framework for Decision Making

Articles for tag: diagnosis, medication, prescribing, psychiatry, schizophrenia, treatment, treatment-resistant schizophrenia

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