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Papers by Subimal Banerjee

Psychotic disorders in learning disabilities- outcome of an audit across community teams

British Journal of Learning Disabilities, May 4, 2011

Accessible summary • We studied the medical notes of 28 service users with learning disability wh... more Accessible summary • We studied the medical notes of 28 service users with learning disability who also had a mental illness called psychosis. • We noted which antipsychotic medication (medicines to treat psychosis) was prescribed and whether we enquired for side effects ...

Screening of Alcohol Misuse in Patients with Intellectual Disabilities

The Online Journal of Clinical Audits, 2015

Introduction – As individuals with intellectual disabilities are now living longer due to improve... more Introduction – As individuals with intellectual disabilities are now living longer due to improved care and treatment of co-morbid conditions, there is also growing evidence that some individuals from this population misuse alcohol. This has led to increased concern regarding the impact on mortality, morbidity and behavioural effects of substance misuse within intellectual disability population. Despite improved awareness about alcohol related health problems in general population, studies in this area in people with intellectual disabilities is very limited. NICE guideline recommends that staff working in services provided and funded by the NHS who care for people who potentially misuse alcohol should be competent to identify harmful drinking and alcohol dependence. Aims – To define what percentages of PWID (People with Intellectual disabilities) in Oxfordshire & Buckinghamshire have been screened for alcohol misuse in accordance with NICE Guideline CG115 Methods – A simple sample ...

Oxford medical case reports, 2017

A 19-year-old male with 22q11.2 deletion syndrome presented with a 4-year history of cognitive de... more A 19-year-old male with 22q11.2 deletion syndrome presented with a 4-year history of cognitive decline and symptoms suggestive of atypical psychosis. Potential for elevated homocysteine and NMDA-receptor antibodies in the pathogenesis of his symptoms was investigated. He had elevated blood homocysteine level (18.7 μmol/l), low-normal vitamin B12 and folate levels and was positive for NMDA-receptor antibodies. Treatment with daily folinic acid (0.8 mg) and vitamin B12 (1 mg) led to dramatic improvement in his cognitive and behavioural presentation. Subsequent plasma exchange resulted in a further, significant clinical improvement. Homocysteine levels and NMDA-R antibodies should be investigated as potential causes of behavioural and cognitive symptoms in patients with 22q11.2 deletion syndrome.

Journal of Medical Hypotheses and Ideas, 2015

Traditionally, two divergent approaches are used to explain the mechanism of action of psychotrop... more Traditionally, two divergent approaches are used to explain the mechanism of action of psychotropic drugs. The dominant ''Disease-centred" view emphasises the biochemical imbalance caused by 'illnesses'. In contrast the ''Drug-centred" view emphasises the psychoactive properties of these drugs and their ability to induce an 'altered-state' of mind. In this article we propose a new paradigm for classifying the therapeutic uses of psychotropic drugs based on the relation between their psychoactive effects and symptoms of indicated mental illness; as well as their clinical responses e.g. emerging tolerance, paradoxical initial worsening and being recommended for long/ short term use. Based on this premise, therapeutic uses of psychotropic drugs can be placed on a continuum between two distinguishable modes. We define these modes as ''Psycho-antagonistic" and ''Psycho-agonistic". 105 therapeutic uses of 85 psychotropic drugs are placed on this continuum; 74% on the Psycho-agnostic spectrum and 25% on the Psycho-antagonistic side. Hypnotic agents used for insomnia are clear examples of Psycho-antagonistic mode of use. Citalopram for treatment of Panic disorder is a clear example of using a drug in Psycho-agonistic mode. Only the therapeutic use of Lithium for bipolar affective disorder could not be allocated to any mode and considered as borderline. The paradigm highlights the possibility of initial worsening in majority of therapeutic uses of psychotropic drugs and importance of using lower doses. Further studies and clinical trials are needed to explore the full extent of the clinical implications of this paradigm in psychiatry and perhaps in other branches of medicine.

The use of Contraception in Patients with Severe and Profound Intellectual Disabilities in Buckinghamshire and Oxfordshire

ABSTRACT

Policy-driven practice: help or hindrance to medical training?

The Clinical Teacher, 2015

Medical education underpins the delivery of clinical services worldwide. As a result, organisatio... more Medical education underpins the delivery of clinical services worldwide. As a result, organisational challenges in health care provision affect the quality of clinical teaching in those settings, either directly or indirectly. In this article, we use recent challenges in health care services within the UK context to explore the potential impact of a policydriven culture on the quality of medical training through the application of educational theories of culture and refl ective thinking. 1–3 We suspect similar issues will arise in other countries and in other disciplines.

Progress in Neurology and Psychiatry, 2014

Psychotic disorders in learning disabilities- outcome of an audit across community teams

British Journal of Learning Disabilities, 2011

Accessible summary • We studied the medical notes of 28 service users with learning disability wh... more Accessible summary • We studied the medical notes of 28 service users with learning disability who also had a mental illness called psychosis. • We noted which antipsychotic medication (medicines to treat psychosis) was prescribed and whether we enquired for side effects ...

Anaesthesia, 2005

SummaryThe European Working Time Directive and the New Deal have decreased the number of hours wo... more SummaryThe European Working Time Directive and the New Deal have decreased the number of hours worked by anaesthetic trainees. We implemented the Working Time Directive in May 2004 and evaluated the effect of its implementation on training. During two 6‐month periods, one before and one after the change, we determined the number of operating lists undertaken by each Specialist Registrar in Anaesthesia. After implementation of the Working Time Directive, the mean number of lists performed by Specialist Registrars decreased from 24 to 21 lists per registrar per month, a 13% decrease. Exposure to subspecialty lists was the same in both periods, but this was at the expense of general lists and those in remote locations. We conclude that the Working Time Directive has had a measurable impact on the training of paediatric anaesthetists, but that the significance of this change for clinical practice has not yet been measured.

Progress in Neurology and Psychiatry, 2016

Psychotic disorders in learning disabilities- outcome of an audit across community teams

British Journal of Learning Disabilities, May 4, 2011

Accessible summary • We studied the medical notes of 28 service users with learning disability wh... more Accessible summary • We studied the medical notes of 28 service users with learning disability who also had a mental illness called psychosis. • We noted which antipsychotic medication (medicines to treat psychosis) was prescribed and whether we enquired for side effects ...

Screening of Alcohol Misuse in Patients with Intellectual Disabilities

The Online Journal of Clinical Audits, 2015

Introduction – As individuals with intellectual disabilities are now living longer due to improve... more Introduction – As individuals with intellectual disabilities are now living longer due to improved care and treatment of co-morbid conditions, there is also growing evidence that some individuals from this population misuse alcohol. This has led to increased concern regarding the impact on mortality, morbidity and behavioural effects of substance misuse within intellectual disability population. Despite improved awareness about alcohol related health problems in general population, studies in this area in people with intellectual disabilities is very limited. NICE guideline recommends that staff working in services provided and funded by the NHS who care for people who potentially misuse alcohol should be competent to identify harmful drinking and alcohol dependence. Aims – To define what percentages of PWID (People with Intellectual disabilities) in Oxfordshire & Buckinghamshire have been screened for alcohol misuse in accordance with NICE Guideline CG115 Methods – A simple sample ...

Oxford medical case reports, 2017

A 19-year-old male with 22q11.2 deletion syndrome presented with a 4-year history of cognitive de... more A 19-year-old male with 22q11.2 deletion syndrome presented with a 4-year history of cognitive decline and symptoms suggestive of atypical psychosis. Potential for elevated homocysteine and NMDA-receptor antibodies in the pathogenesis of his symptoms was investigated. He had elevated blood homocysteine level (18.7 μmol/l), low-normal vitamin B12 and folate levels and was positive for NMDA-receptor antibodies. Treatment with daily folinic acid (0.8 mg) and vitamin B12 (1 mg) led to dramatic improvement in his cognitive and behavioural presentation. Subsequent plasma exchange resulted in a further, significant clinical improvement. Homocysteine levels and NMDA-R antibodies should be investigated as potential causes of behavioural and cognitive symptoms in patients with 22q11.2 deletion syndrome.

Journal of Medical Hypotheses and Ideas, 2015

Traditionally, two divergent approaches are used to explain the mechanism of action of psychotrop... more Traditionally, two divergent approaches are used to explain the mechanism of action of psychotropic drugs. The dominant ''Disease-centred" view emphasises the biochemical imbalance caused by 'illnesses'. In contrast the ''Drug-centred" view emphasises the psychoactive properties of these drugs and their ability to induce an 'altered-state' of mind. In this article we propose a new paradigm for classifying the therapeutic uses of psychotropic drugs based on the relation between their psychoactive effects and symptoms of indicated mental illness; as well as their clinical responses e.g. emerging tolerance, paradoxical initial worsening and being recommended for long/ short term use. Based on this premise, therapeutic uses of psychotropic drugs can be placed on a continuum between two distinguishable modes. We define these modes as ''Psycho-antagonistic" and ''Psycho-agonistic". 105 therapeutic uses of 85 psychotropic drugs are placed on this continuum; 74% on the Psycho-agnostic spectrum and 25% on the Psycho-antagonistic side. Hypnotic agents used for insomnia are clear examples of Psycho-antagonistic mode of use. Citalopram for treatment of Panic disorder is a clear example of using a drug in Psycho-agonistic mode. Only the therapeutic use of Lithium for bipolar affective disorder could not be allocated to any mode and considered as borderline. The paradigm highlights the possibility of initial worsening in majority of therapeutic uses of psychotropic drugs and importance of using lower doses. Further studies and clinical trials are needed to explore the full extent of the clinical implications of this paradigm in psychiatry and perhaps in other branches of medicine.

The use of Contraception in Patients with Severe and Profound Intellectual Disabilities in Buckinghamshire and Oxfordshire

ABSTRACT

Policy-driven practice: help or hindrance to medical training?

The Clinical Teacher, 2015

Medical education underpins the delivery of clinical services worldwide. As a result, organisatio... more Medical education underpins the delivery of clinical services worldwide. As a result, organisational challenges in health care provision affect the quality of clinical teaching in those settings, either directly or indirectly. In this article, we use recent challenges in health care services within the UK context to explore the potential impact of a policydriven culture on the quality of medical training through the application of educational theories of culture and refl ective thinking. 1–3 We suspect similar issues will arise in other countries and in other disciplines.

Progress in Neurology and Psychiatry, 2014

Psychotic disorders in learning disabilities- outcome of an audit across community teams

British Journal of Learning Disabilities, 2011

Accessible summary • We studied the medical notes of 28 service users with learning disability wh... more Accessible summary • We studied the medical notes of 28 service users with learning disability who also had a mental illness called psychosis. • We noted which antipsychotic medication (medicines to treat psychosis) was prescribed and whether we enquired for side effects ...

Anaesthesia, 2005

SummaryThe European Working Time Directive and the New Deal have decreased the number of hours wo... more SummaryThe European Working Time Directive and the New Deal have decreased the number of hours worked by anaesthetic trainees. We implemented the Working Time Directive in May 2004 and evaluated the effect of its implementation on training. During two 6‐month periods, one before and one after the change, we determined the number of operating lists undertaken by each Specialist Registrar in Anaesthesia. After implementation of the Working Time Directive, the mean number of lists performed by Specialist Registrars decreased from 24 to 21 lists per registrar per month, a 13% decrease. Exposure to subspecialty lists was the same in both periods, but this was at the expense of general lists and those in remote locations. We conclude that the Working Time Directive has had a measurable impact on the training of paediatric anaesthetists, but that the significance of this change for clinical practice has not yet been measured.

Progress in Neurology and Psychiatry, 2016