6 results
Evaluation of Films That Depict People With Dementia
- Arwa Jibril, Ross Overshott
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S66-S67
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Aims
Films are known to influence the public's perception about mental health conditions. Dementia's prevalence in society has been increasing due to the ageing population. Cinema has long struggled with its depiction of mental health as seen with the depiction of schizophrenia, autism and psychosis in many blockbusters and award winning films. However, the depiction of dementia in films has not been as widely explored. The aim of this paper is to evaluate the depiction of dementia in films to assess its clinically accuracy.
MethodsA systematic search of keywords related to dementia was completed on the Internet Movie Database. The search was conducted in May 2022. Non-foreign language feature films were used in this paper. Films from 2000 and onwards were used. The films were analysed on the type of dementia they portrayed. 8 themes and tropes were assessed for each film. The portrayal of healthcare was also assessed. Each film was measured against the Neuropsychiatric Inventory-Questionnaire.
Results42 films were used from an initial sample of 1,320. Alzheimer's was found to be the most frequently portrayed cause of dementia. Time-shifting was the most common theme. There was a predominantly negative portrayal of care homes with a positive portrayal of carers. The films, measured against the NPI-Q, produced on average a lower severity of neuropsychiatric symptom score and carer distress score.
ConclusionThe depiction of dementia was mild in comparison to dementia's clinical manifestation. Films showed a positive portrayal of healthcare workers which can be considered rare when looking at cinema's history with psychiatry. Overall, films did not accurately portray the clinical aspect of dementia as they tended to focus more on the early stages of the diagnosis. However, films were realistic in their depiction of the emotional challenges that comes with a diagnosis of dementia. Film's powerful role in influencing the public's perception could be used to help reduce stigma and misunderstanding. Filmmakers could work with clinicians to help produce accurate portrayals of dementia. Patients experience the emotive aspect of their diagnosis but also equally experience the symptomatic aspects and cinema should be able to embody that. An accurate portrayal can still maintain the appeal of cinema and at the same time help with reducing misunderstanding and stigma held by the public about dementia which can help improve health outcomes.
Trends in referrals to liaison psychiatry teams from UK emergency departments for patients over 65
- Sarah Bradbury, George Crowther, Manimegalai Chinnasamy, Laura Shaw, Sara Ormerod, Alison Wilkinson, Rebecca Chubb, Mazen Daher, Pramod Kumar, Andrew Gaskin, Karen Williams, Angus Brown, Eleanor Stebbings, Sunita Sahu, Roger Smyth, Hilary Kinsler, Stephen O'Connor, Andrew Wells, Ross Overshott, Kehinde Junaid, Aparna Mordekar, Jenny Humphries, Karen James, Shweta Mittal, Sarita Dasari, Hugh Grant-Peterkin, Niall Campbell, Robert West, Professor George Tadros, Elizabeth Sampson
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S311-S312
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Aims
The number of people over the age of 65 attending Emergency Departments (ED) in the United Kingdom (UK) is increasing. Those who attend with a mental health related problem may be referred to liaison psychiatry for assessment. Improving responsiveness and integration of liaison psychiatry in general hospital settings is a national priority. To do this psychiatry teams must be adequately resourced and organised. However, it is unknown how trends in the number of referrals of older people to liaison psychiatry teams by EDs are changing, making this difficult.
MethodWe performed a national multi-centre retrospective service evaluation, analysing existing psychiatry referral data from EDs of people over 65. Sites were selected from a convenience sample of older peoples liaison psychiatry departments. Departments from all regions of the UK were invited to participate via the RCPsych liaison and older peoples faculty email distribution lists. From departments who returned data, we combined the date and described trends in the number and rate of referrals over a 7 year period.
ResultReferral data from up to 28 EDs across England and Scotland over a 7 year period were analysed (n = 18828 referrals). There is a general trend towards increasing numbers of older people referred to liaison psychiatry year on year. Rates rose year on year from 1.4 referrals per 1000 ED attenders (>65 years) in 2011 to 4.5 in 2019 . There is inter and intra site variability in referral numbers per 1000 ED attendances between different departments, ranging from 0.1 - 24.3.
ConclusionTo plan an effective healthcare system we need to understand the population it serves, and have appropriate structures and processes within it. The overarching message of this study is clear; older peoples mental health emergencies presenting in ED are common and appear to be increasingly so. Without appropriate investment either in EDs or community mental health services, this is unlikely to improve.
The data also suggest very variable inter-departmental referral rates. It is not possible to establish why rates from one department to another are so different, or whether outcomes for the population they serve are better or worse. The data does however highlight the importance of asking further questions about why the departments are different, and what impact that has on the patients they serve.
Dramatic portrayal of suicide: a critical analysis of Netflix's 13 Reasons Why
- Anna Sutton, Ross Overshott
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S294
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The aims of this project were to assess how well the Netflix drama 13 Reasons Why portrayed suicide, in terms of both accuracy and safety, and to discuss the potential effect this could have on viewers.
BackgroundPsychiatric content within dramatic media can have measurable effects on the population, such as reinforcing stigma around mental illness. Given the show's focus on a character's suicide, the most serious effect here would be suicide contagion.
Guidelines and regulations for the portrayal of suicide in media are in place to protect those who might be vulnerable to suicide contagion.
MethodWe formed our own pro-forma of 42 criteria using existing guidelines written for both news and dramatic media. These criteria were formatted into positive and negative pairs; positive being instances of guidelines being followed, negative as guidelines being broken. These were further organised into 7 categories.
Each episode of seasons 1-2 was then assessed against the criteria. Cumulative instances of guidelines being followed or broken were compared within and between seasons. Context of each instance was taken into account by the primary researcher, and we also highlighted instances of exceptional breach of these guidelines.
ResultThe results showed an over-all breach of the guidelines, with no significant improvement between the seasons. Some categories of criteria, such as “asking for help” and “mental health”, were portrayed well overall. Other categories, such as “blame”, performed extremely badly.
The most significant breach was the graphic suicide scene at the end of the first season, which completely disregarded Samaritans’ guidelines.
ConclusionThe breaching of guidelines in this show was overwhelming. In terms of severity, although there were some positive themes running through the seasons, there were also worrying instances of guidelines being completely disregarded. This led to the conclusion that the producers of the show did not take their responsibility to young, vulnerable viewers seriously regarding the dangers around portraying suicide.
Suggestions from this study are that more guidelines around suicide are needed specifically for dramatic media, and that existing guidelines should be conflated and have stronger implementation by regulators. This implementation should potentially include overseas providers such as Netflix. Ethically, a significant challenge here is maintaining balance between safety and allowing artistic licence.
1 - History and structure of the National Health Service
- from Part I - Theoretical overview
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- By Ross Overshott, Consultant Psychiatrist, Greater Manchester West Mental Health NHS Foundation Trust, Alistair Burns, Professor of Old Age Psychiatry, University of Manchester and National Clinical Director for Dementia and Older People's Mental Health, NHS England, Dinesh Bhugra, CBE, President, World Psychiatric Association
- Edited by Dinesh Bhugra, Stuart Bell, Alistair Burns
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- Book:
- Management for Psychiatrists
- Published online:
- 02 January 2018
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- 23 September 2016, pp 3-27
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Summary
It is perhaps important for everyone working in the National Health Service (NHS) to have some idea of the origins, development and current structure of what is one of the biggest and most complicated organisations in the world. A detailed analysis of the NHS and its history is outside the scope of this chapter; suggestions for further reading are given at the end. Its purpose is instead to outline briefly how the NHS has evolved and to put into perspective the current changes.
Healthcare before the NHS
Until the middle of the 19th century, the state had virtually no control over the medical profession. Doctors had developed their own organisational structure which satisfied the need for self-protection. Members of the Royal College of Physicians mainly worked in the London teaching hospitals and treated those who could afford their fees. Members of the Royal College of Surgeons (which was the Company of Barbers a century before) were more experienced in the practice of medicine and treated patients both in London (in competition with the physicians) and outside. The vast majority of people were treated at the hands of members of the Society of Apothecaries, who basically prescribed medication. For a considerable time churches provided forms of treatment to people with mental illnesses.
The state became more involved in the health of the population and regulation of the medical profession throughout the 19th century and in the early 20th century. The 1834 Poor Law was the first acknowledgement that government had some responsibility for the care of the population. Among its effects was the statutory provision of a parish medical officer to care for the poor. These established that the parish workhouses should have sick wards where the able-bodied inmates could be treated when they became ill (Levitt, 1976). Free services were offered by boards of guardians to those who could pass a means test.
The Public Health Act 1848 established statutory powers that enabled a local medical officer of health (an official of the local authority) to cater for the health of the local population. Following the Poor Law reforms, the medical officers’ responsibilities were extended to some Poor Law hospitals which were considered to be providing healthcare rather than welfare.
Rivastigmine in the treatment of delirium in older people: a pilot study
- Ross Overshott, Martin Vernon, Julie Morris, Alistair Burns
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- Journal:
- International Psychogeriatrics / Volume 22 / Issue 5 / August 2010
- Published online by Cambridge University Press:
- 31 March 2010, pp. 812-818
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Background: Delirium is common in the elderly and is associated with high mortality and negative health outcomes. Reduced activity in the cholinergic system has been implicated in the pathogenesis of delirium. Cholinesterase inhibitors, which increase cholinergic activity, may therefore be beneficial in the treatment of delirium.
Methods: This is a double-blind, placebo-controlled randomized pilot study of the treatment of delirium with a cholinesterase inhibitor of patients admitted to hospital medical wards. Patients over the age of 65 years were identified as having delirium by the Confusion Assessment Method (CAM). Patients with delirium were randomized to receive rivastigmine 1.5 mg once a day increasing to 1.5 mg twice a day after seven days or an identical placebo (two tablets after seven days).
Results: Fifteen patients entered the trial; eight received rivastigmine and seven received placebo. All of the rivastigmine group, but only three of the placebo group, were negative for delirium on the CAM when they left the study and eventually discharged home. There was no significant difference in the duration of delirium between the two groups (rivastigmine group 6.3 days versus placebo group 9.9 days, p = 0.5, 95% confidence interval −15.6–8.4).
Conclusions: The numbers of patients who screened positive for delirium was very small and as a result the sample size was too small to make any meaningful inferences about treatment of delirium. Despite the small numbers included in the study, there are some indicators that rivastigmine may be safe and effective in treating delirium.
Cholinesterase inhibitors: in search of cholinergic deficits
- Ross Overshott, Alistair Burns
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- Journal:
- Advances in Psychiatric Treatment / Volume 11 / Issue 5 / September 2005
- Published online by Cambridge University Press:
- 02 January 2018, pp. 321-324
- Print publication:
- September 2005
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