Guidelines on suicide amongst anaesthetists 2019.

Anaesthetists are thought to be at increased risk of suicide amongst the medical profession. The aims of the following guidelines are: increase awareness of suicide and associated vulnerabilities, risk factors and precipitants; to emphasise safe ways to respond to individuals in distress, both for them and for colleagues working alongside them; and to support individuals, departments and organisations in coping with a suicide.

The diagnosis and management of insomnia in the United Kingdom Armed Forces.

Insomnia is a common condition among patients presenting to primary care facilities in both civilian and military populations. This article considers the diagnosis, management and clinical considerations of managing this condition, along with the occupational and operational considerations for the United Kingdom Armed Forces.

A proposed model for community-assisted alcohol withdrawal in primary care in the UK Armed Forces.

Alcohol misuse and related morbidity continues to represent a challenge to the both the National Health Service (NHS) and the Defence Medical Services (DMS). A significant part of the management of patients who misuse alcohol involves planned assisted withdrawal for dependent drinkers. Traditionally, assisted alcohol withdrawal has been conducted in an in-patient setting owing to the perceived risks of carrying out this treatment. Current evidence shows that community-based approaches offer a safe and effective alternative to the traditional in-patient model with significant cost savings. This article proposes a model for community-assisted alcohol withdrawal (CAAW) for use within the DMS. It considers current guidelines and models already in operation within the NHS, offering evaluation and adjustments to fit the requirements that are applicable to the UK Armed Forces medical environment.

Alcohol dependence in the Naval Service.

Alcohol misuse is a significant occupational health issue in the United Kingdom Armed Forces. Dependence associated with alcohol misuse represents the severe end of the clinical and occupational consequences of sustained alcohol misuse. This article aims to explore the diagnosis, management and occupational considerations of alcohol dependence in the Naval Service environment.

The psychopharmacological treatment of depression in primary care in the Royal Navy.

Depression is a common mental health condition in the UK Armed Forces. Although psychopharmacology is usually a second line intervention, there is a place for antidepressants in the management of depression in primary care. This article will examine the diagnosis of depression, the indications for starting antidepressants, the choice of anti-depressants and the occupational considerations in the Royal Navy. The aim is to equip General Practitioners (GPs) and General Duties Medical Officers (GDMOs) with the clinical information needed to initiate psychopharmacological treatment for depression where indicated.

The diagnosis and management of psychogenic non-epileptic seizures in the UK Armed Forces.

Psychogenic non-epileptic seizures (PNES) is a disorder that mimics epilepsy, but does not have the associated organic changes or abnormal neuronal discharge foci in the brain. In this article the diagnosis, management and clinical considerations of managing this condition in the UK Armed Forces are considered. The occupational and operational considerations for the military environment are also discussed.

The primary care diagnosis and management of social phobia and its relevance in the UK Armed Forces.

Social phobia can be a distressing anxiety disorder that in the clinical experience of the authors may be under-recognised in the UK Armed Forces. In this article we consider the diagnosis and management of social phobia. We also discuss the occupational and operational considerations for the military environment.

Diagnosis, management and operational impact of panic disorder in the UK Armed Forces.

Panic Disorder, with or without agoraphobia, is a common anxiety disorder found in patients presenting in the Primary Care setting, and there is some evidence to suggest that it may not be a rare phenomenon in military populations. This article aims to discuss recognition of the disorder, awareness of its differential diagnoses, and management in Primary Care, particularly if secondary care referrals are not readily available. The National Institute for Clinical Excellence (NICE) Guidelines, both pharmacological and psychological, will be considered. Finally, the impact of Panic Disorder in relation to the Armed Forces in the training and deployed environment will be considered.

The primary care diagnosis and management of bulimia nervosa and its relevance in the UK Armed Forces.

Bulimia Nervosa is an eating disorder that is frequently seen in the UK Armed Forces population. In this article the diagnosis, management and clinical considerations of managing this condition in Primary Care in the UKArmed Forces are considered. The occupational and operational considerations for the military environment are also discussed.

Bullying and the UK Armed Forces.

There are certain characteristics of the culture and environment in the Armed Forces that may be conducive to bullying. In this article we examine the cultural and environmental factors that may encourage such behaviour and those that act as deterrents for victims to come forward. We will look at the scope of this problem within the UK Armed Forces specifically, before more generally considering the psychological impact of bullying. There appears to be an overall downward trend in bullying within the UK Armed Forces and a positive increase in complaints as more victims step forward. We conclude by highlighting some areas for further development.

Detecting post-deployment mental health problems in primary care.

Post-deployment mental health problems are a source of potential concern for health professionals and politicians in military forces in the world; the UK Armed Forces are no exception. This article examines practical ways in which General Practitioners in Primary Care can enhance their ability to detect post-deployment mental health problems and offers suggestions on immediate management and assessment, based on contemporary evidence and clinical experience.

The doctor vs. the Command: can disagreement arise?

Doctors have long since assisted the Command on operations and in providing day to day bespoke medical care to the UK Armed Forces. Doctors and the Command work along different models that confer different obligations and priorities. For doctors the patient and their wellbeing is of primary importance and for the Command, the Unit as a whole with its military goals are of primary concern. Most of the time these two models work in harmony. However occasionally disagreement can arise. This article examines the models guiding their respective practice in order to understand the underpinnings of these disagreements, and offers some discussion of the issues, particularly as they pertain to the deployed environment. Finally, some recommendations are made to equip doctors and the Command to contain any disagreements.

The attitudes of carers and old age psychiatrists towards the treatment of potentially fatal events in end-stage dementia.

BACKGROUND: Deciding how to treat patients with end-stage dementia developing potentially fatal events has long been contentious. Under expected new legislation the role of carers is likely to increase. Old age psychiatrists frequently have to decide between active or palliative approaches to such patients. Little is known concerning the comparative attitudes of carers and old age psychiatrists. This research examined how their attitudes differed. METHODS: A Likert scale attitudinal questionnaire was designed following a literature review and was initially distributed to a pilot group of medical students to aid in establishing reliability and validity. Subsequently it was sent to all members of the local Alzheimer's Society Branch and all the old age psychiatrists in the health region. Its validity and reliability were investigated using factor analysis and test-retest reliability. Between group comparisons were then made using the students t-test and analysis of variance. RESULTS: 148 carers and 34 clinicians responded. Factor analysis and test-retest analysis of students' responses validated six questions, which grouped into two factors, relating to active treatment and patient-centred ethics. Between group comparisons revealed significant differences between carers' and clinicians' attitudes in these areas. Clinicians favoured active treatment of potentially fatal events in end-stage dementia less than carers who more significantly valued patient-centred issues such as dying with dignity, the patient's best interests and the patient's wishes. CONCLUSIONS: Old age psychiatrists and carers significantly differed in their attitudes towards treatment of potentially fatal events in end-stage dementia and this may impact on decision-making. Considerably more clinician/carer debate and dialogue seems needed.