There is evidence that changing diagnoses may be an important factor preceding homicide, but there is little literature on diagnostic antecedents to admission to specialist secure units after violent behaviour. Our aim was to establish the frequency of a history of changing diagnoses in patients in a UK specialist unit, and to explore the characteristics of these patients.

In total, 38 of 42 study participants had prior contact with psychiatric services. Just over 40% (16 of the 38) had had their diagnosis changed three or more times. All those who had major changes in their diagnosis had received a diagnosis of a psychotic illness at some point prior to the secure unit admission, but then had it withdrawn, only to be restored after prolonged assessment in the secure unit. Personality disorder and substance misuse comorbidity was common in this group; however, non-psychotic diagnoses were seen as more important than psychotic diagnoses by general services.

Changes in diagnosis between first presentation to psychiatric services and admission to a medium-security unit were more common than would be expected from reports in the general literature. They are a testimony to the difficulties experienced by service providers in delivering a consistent service. This needs to be studied further.

In 2011, a psychiatric clinic was started in Pusat Al-Islah, a drug rehabilitation centre. Our aim was to record self-reported socio-occupational dysfunction and patterns of drug misuse and to evaluate the usefulness of a psychiatric screening tool. A two-phased approach using the Self-Reporting Questionnaire (SRQ) and the Mini International Neuropsychiatric Interview (MINI) was used to examine the rates of psychiatric diagnoses.

Methamphetamine was the most commonly misused substance in 94.5% of residents. High levels of socio-occupational dysfunction were reported. In total, 5.5% met criteria for major depressive disorder, 4.8% for lifetime psychotic disorder and 11.5% for suicidal ideation. In addition, 13.3% reported previous untreated mental health problems.

A screening tool such as the SRQ can be used to identify those needing further psychiatric assessment. Interventions to address amphetamine misuse and associated socio-occupational dysfunction are required. Societal views and legislation influence the management of substance misuse problems in Brunei.

The aim of the study was to examine treatment for the initial acute phase of first-episode psychosis at the Early Psychosis Prevention and Intervention Centre. Information regarding treatment was collected from file notes for all patients (n=112). For a subsample of patients (n=68), remission of positive psychotic symptoms was assessed using standardised ratings at 3-month follow-up.

Treatment provided was largely in accordance with recommended treatment strategies. The majority (72%) of patients achieved rapid remission of positive symptoms.

Restrictive practices other than in-patient admission, such as in-patient seclusion, police transport or a community treatment order, can be minimised. The use of low-dose antipsychotic medication is an effective treatment strategy for the initial acute phase of first-episode psychosis.

This paper analyses how practice varied between patients aged <65 and ≥65 years in the 2019 UK national memory service audit.

Data on 3959 patients were analysed. Those aged <65 (7% of the sample) were less likely than those aged ≥65 to be diagnosed with dementia (23 v. 67%) and more likely to receive a functional, psychiatric or no diagnosis. Younger patients were more likely to have magnetic resonance imaging; use of dementia biomarkers was low in both groups. Frontotemporal dementia and functional cognitive disorder were diagnosed infrequently. Use of dementia navigators/advisors and carer psychoeducation was similar between groups; younger patients were less likely to be offered but more likely to accept cognitive stimulation therapy.

Memory services seeing younger people need expertise in functional cognitive disorder, alongside clinical skills and technologies to diagnose rarer forms of dementia. Further work is needed to understand why cognitive stimulation therapy is less frequently offered to younger people.

To compare differences in clozapine doses and plasma levels between Bangladeshi and White British patients. Following ethical approval we identified all current Bangladeshi and White British patients on clozapine maintenance in an east London clinic. We carried out univariate and multivariate regression analyses to examine associations between clozapine doses and ethnicity, age, gender, smoking status and weight. We also compared plasma clozapine levels of the two groups.

On univariate analysis White British patients had on average 85 mg higher doses than Bangladeshi patients (P = 0.004). Older age, male gender and smoking were also associated with higher dose. On multivariate analysis only age and smoking status remained significant. A greater proportion of Bangladeshi patients had high plasma clozapine levels compared with White British (30.76% v. 20.75%), although the difference was not statistically significant.

Our findings point to the need for the broadening of data collection on ethnic differences in clozapine prescribing within big data-sets such as Prescribing Observatory for Mental Health (POM-UK). Ethnopharmacological variations can inform more person-centred guidance on prescribing.

We assessed 92% (117/127) of the patients in our community mental health learning disability team using the Mental Health Clustering Tool (MHCT) to establish whether their needs could be captured sufficiently well to enable assignment to a care cluster for payment by results in mental health. We explored the characteristics of those assigned to Cluster 0 to identify how they differed from those who could be assigned to Clusters 1-21.

As expected, nearly half of the case-load (48%) could not be assigned to any cluster except Cluster 0, the variance cluster, which is used when the needs of patients cannot be captured by the current 21 care clusters but a service is, or will be, provided.

The MHCT in its current form does not adequately capture the needs of people with more severe intellectual disability. An integrated mental health and learning disability clustering tool is in development. This is expected to include new rating scales and new clusters, however until the development is completed and validated it will not be possible to implement payment by results in mental health in learning disability services.