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1.  Screening for suicidal thoughts in primary care: the views of patients and general practitioners 
Mental Health in Family Medicine  2008;5(4):229-235.
Background It has been argued that primary care practitioners have an important part to play in the prevention of suicide. However, levels of assessment of risk of suicide among patients treated in this setting are generally low.
Methods Cross-sectional survey of general practitioners (GPs) and people being treated in primary care who had signs of depression. The study combined open and closed questions on attitudes to screening or being screened for suicidal ideation.
Results One hundred and one of 132 patients took part in the survey and 103 of 300 GPs completed a questionnaire. A majority of both GPs and patients stated that people should be screened for suicidal ideation. However, an important minority of patients and GPs stated that asking or being asked such questions made them feel uncomfortable. Less than half of GPs had received formal training on the assessment of suicide risk. GPs told the researchers that barriers to screening included time pressures, culture and language, and concerns about the impact that screening could have on people's mental health. One-quarter of GPs and one-fifth of patients supported the notion that screening for suicidal ideation could induce a person to have thoughts of self-harm.
Conclusions GPs and family doctors should screen for suicidal risk among depressed patients and should receive training on how to do this as part of their general training in the assessment and management of mental disorders. Research should be conducted to examine what, if any, effect screening for suicidal ideation has on mental health.
PMCID: PMC2777583  PMID: 22477874
primary care; screening; suicide
2.  What should prompt an urgent referral to a community mental health team? 
Mental Health in Family Medicine  2008;5(4):197-201.
Background There is often little guidance to advise general practitioners on whether a referral to a community mental health team should be classified as ‘urgent’ or not.
Aims (1) To identify the proportion and appropriateness of referrals considered urgent by the referrer; (2) To develop a set of criteria to guide what should constitute an ‘urgent’ referral.
Methods One hundred consecutive referral letters to a community mental health team were analysed to determine the proportion that were considered urgent by the referrer compared to a consensus panel of psychiatrists. A Delphi group was then used to develop a set of criteria to guide referrers as to what should be regarded as an urgent referral.
Results Thirty-three percent of referrals were deemed urgent by the referrer, compared to 17% by the psychiatric consensus panel, with little agreement between the two (kappa = 0.021, P = 0.013). Referrals that were made using a single assessment process (SAP) form were significantly more likely to be inappropriately marked as being urgent (P < 0.001). A set of 12 criteria was developed using the Delphi technique.
Conclusions There was significant disagreement between the referrers and the assessing team as to which referrals required urgent attention. The findings justified the creation of guidelines, and this paper outlines a set of 12 criteria to guide what should prompt an urgent referral.
PMCID: PMC2777582  PMID: 22477870
community mental health services; Delphi technique; primary health care
Indian Journal of Psychiatry  1999;41(2):96-99.
Thirty patients suffering from schizophrenia (diagnosed as per DSM-IV criteria), for more than 2 years and having predominant negative symptoms were started on risperidone (2-10 mg/day) and were followed up over a period of 16 weeks. The improvement was assessed using PANSS (Positive and Negative Syndrome Scale).
During this 16 weeks follow up, it was interestingly noted that though there was a significant improvement in negative symptoms in all the patients, in 7 patients there was a reemergence of positive symptoms. Four patients had increase in rating on suspiciousness and hostility and two patients reported auditory hallucinations. One patient developed delusions and conceptual disorganization along with suspiciousness and hostility.
PMCID: PMC2962850  PMID: 21455369
Risperidone; positive symptoms; schizophrenia

Results 1-3 (3)