Rob Poole

Psychiatry after Kraepelin: Ambition Images Practices 1926–2026 Edited by George Ikkos and Thomas Becker. Springer. 2026. £44.99 (hb). 580 pp. ISBN 978-3032094742 - Volume 229 Issue 4

Summary: Patients find the term ‘borderline personality disorder’ offensive and, from a list of alternative labels, prefer ‘emotional intensity disorder’. It is suggested that any term will take on a pejorative connotation if professional attitudes do not change as well; and that this requires an alteration in the environment in which professionals operate. This should not look so strongly to compulsion to prevent suicide, but should allow therapeutic relationships to flourish. Blaming clinicians for incidents when they have few choices is counterproductive. The problem reflects a systemic impatience with patients who get better slowly or not at all.

Objectives: To evaluate the impact of a pharmacist-led primary care review clinic on reducing opioid prescribing. Methods: Retrospective analysis of routinely collected opioid prescription data for patients using strong opioids for pain at a practice with high social deprivation and staffed mainly by locum GPs. Key findings: Forty-seven patients were reviewed. The median opioid dose before review was 80 mg oral morphine equivalent. After intervention, the median dose was 30 mg. Thirty-seven (78.7%) patients had reduced doses or discontinued opioids. No adverse events were reported. Conclusions: A pharmacist-led clinic aimed at reducing opioid medication appears feasible and effective.

Summary: Lysenko was a powerful Soviet pseudoscientist, whose theories cost millions of lives. He died 50 years ago, but his legacy is highly salient. Anti-science and ideology come together slowly, and UK pseudoscience has had unforeseen consequences. Pseudoscience must be challenged even when this has repercussions for those who speak up.

Background: With a rising prison population, a substantial portion of whom are identified as substance misusers, it is important to understand the availability of treatment pathways, their successes and areas for improvement. Given the likely importance of national factors in criminal justice and substance use service provision, we chose to focus on one country. Aim: To review substance misuse treatment and outcomes for such treatments as implemented in British prisons for men. Methods: We conducted a mixed‐methods systematic review, searching Ovid MEDLINE, Ovid Embase, APA PsycINFO, CINAHL Plus, Sociology Collection, Web of Science Core Collection and Social Science Premium Collection between 1 January 2000 and 5 June 2024. Included were empirical, peer‐reviewed studies of processes and outcomes of UK male prison‐based substance misuse programmes. Primary outcomes included changes in substance use, withdrawal symptoms and experiences of interventions, whereas secondary outcomes encompassed quality of life, locus of control and mental health. Because of study design heterogeneity, meta‐analysis was not possible. Analysis followed JBI methodology with a convergent synthesis. Results: Fourteen studies were included: 8 qualitative, 5 quantitative studies of which 3 were randomised control trials (RCTs) and 1 mixed‐methods study, with a combined sample of 4037 participants engaged in opioid substitute treatment (OST) and/or psychosocial interventions. Four key themes emerged: the power of purposeful activity, strengthening support systems, bridging patient needs with treatment plans and, for those in opiate programmes, experiences and engagement with opioid substitution treatments. Conclusions: Participants articulated diverse treatment needs, highlighting the necessity of individualised and tailored reduction or maintenance plans. Treatment requires a comprehensive approach with the aim of facilitating effective social integration.

Social Justice, Social Discrimination, and Mental Health: Theory, Practice, and Professional Issues By Rachel Tribe and Dinesh Bhugra. Routledge. September 2024. £36.17 (pb). 292 pp. ISBN 978-1-032-395630 - Volume 226 Issue 6

This paper reflects on a special edition of the journal History of Psychiatry and a related symposium held at Somerville College, Oxford, exploring the innovations in mental healthcare in Oxfordshire led by Dr Bertram Mandelbrote between 1959 and 1988. I draw on clinical culture, biography, mental health policy and my lived experience to understand Mandelbrote's life and work, and his legacy and lessons for contemporary psychiatrists. I explore the ecological niche that Mandelbrote created and conclude with the probable importance of his relationship with Professor Michael Gelder, who led the University of Oxford Department of Psychiatry at the time.