To assess the patients' most influential concerns regarding long-acting injectable antipsychotics (LAIs) and mental health professionals' preconceptions about these concerns. For both groups, to assess the level of knowledge about LAIs. This cross-sectional study used semi-structured interviews of patients with schizophrenia or schizoaffective disorder (n = 164), nurses (n = 43) and physicians (n = 20).

The mental health professionals overestimated many of the patients' fears of LAIs, and the expressed fears exceeded the actual experiences of patients already on LAIs. Acceptance to switch to LAIs was associated with shorter time from diagnosis. Nurses and patients disclosed limited knowledge of antipsychotics.

Physicians and nurses should aim to identify the individual patient's concerns about LAIs in the discussion about choice of antipsychotic treatment early in the course of illness.

Schizophrenia is a psychotic disorder that is stereotypically stigmatised as untreatable and associated with violence. Several authorities have suggested that changing the name, for example to psychosis, would reduce such stigmatisation. We aimed to compare attitudes to schizophrenia and psychosis on Twitter to see if psychosis was associated with less negative attitudes. Tweets containing the terms ‘schizophrenia’, ‘schizophrenic’, ‘psychosis’ or ‘psychotic’ were collected on www.twitter.com and were captured with NCapture. On NVivo, tweets were coded into categories based on user type, tweet content, attitude and stigma type by two independent raters. We compared the content and attitudes of tweets referring to schizophrenia/schizophrenic and psychosis/psychotic.

A total of 1120 tweets referring to schizophrenia/schizophrenic and 1080 referring to psychosis/psychotic were identified over two 7-day periods; 424 original tweets for schizophrenia and 416 original tweets for psychosis were included in the analysis. Psychosis was significantly more commonly included in tweets expressing negative attitudes (n=131, 31.5%) than schizophrenia (n=41, 9.7%) (χ² = 237.03, P < 0.0001). Of the personal opinions or dyadic interactions, 125 (53.4%) in the psychosis data set were stigmatising, compared with 33 (24.6%) of those in the schizophrenia set (χ² = 44.65, P < 0.0001).

The terms psychosis/psychotic are associated with a significantly higher number of tweets with negative content than schizophrenia/schizophrenic. Together with other evidence, this suggests that changing the name of schizophrenia to psychosis will not reduce negative attitudes toward the condition.

S.L. has received personal fees from Otsuka and Sunovion, and personal and research fees from Janssen.

Outcome measurement has become increasingly important in brain injury rehabilitation. Health of the Nation Outcome Scale-Acquired Brain Injury (HoNOS–ABI) is a new outcome measure targeting psychiatric and other sequelae of brain injury. Forty patients' scores on three outcome measures and other ecologically valid markers of outcome were compared.

Significant correlation coefficients between HoNOS–ABI and two other outcome measures were found. Post-injury employment status correlated with HoNOS–ABI rating. Although there was a significant increase in need for psychiatric intervention following brain injury, this did not correlate with HoNOS–ABI ratings.

HoNOS–ABI may be a useful additional measure of outcome following brain injury, specifically identifying the often missed psychiatric sequelae of a brain injury.

Modern mental healthcare providers must demonstrate service-level clinical effectiveness to key stakeholders. We introduced two performance indicators of clinical effectiveness based on outcome data from routinely collected Health of the Nation Outcome Scales (HoNOS) and HoNOS–secure assessments across St Andrew's Healthcare, a charity providing in-patient services in Northampton and Essex. We present outcome data from the period 2004–2007.

The indicators showed consistent 90-day improvement rates and increasing stability over time. the validity of results is supported by levels of change along predicted lines among different patient cohorts.

It is possible and beneficial to use routine outcome measures to demonstrate clinical effectiveness at service level. the future of managing mental health outcomes will be in electronic health records systems.

Health promotion campaigns using current terminology have had limited success in reducing stigma to schizophrenia. Terminology and subgroups based on historical precedent, clinical experience and psychosocial research have been developed to provide an alternative to existing terminology, and the attitudes to schizophrenia and alternative terminology of a sample of medical students (n=241) were compared.

Overall attitudes were significantly less negative with the alternatives. the students were less negative about the potential for recovery in relation to all the subgroups than for schizophrenia. Concerns about dangerousness were also less prominent with the exception of the drug-related group.

Subgroups and alternative terminology should be further explored in programmes to destigmatise schizophrenia.

To assess the feasibility of conducting a larger, definitive randomised controlled trial of manual-assisted cognitive therapy (MACT), a brief focused therapy to address self-harm and promote engagement in services. We established recruitment, randomisation and assessment of outcome within a sample of these complex patients admitted to a general hospital following self-harm. We assessed symptoms of depressed mood, anxiety and suicidality at baseline and at 3 months' follow-up.

Twenty patients were randomised to the trial following an index episode of self-harm, and those allocated to MACT demonstrated improvement in anxiety, depression and suicidal ideation.

It is feasible to recruit a sample of these complex patients to a randomised controlled trial of MACT following an index episode of self-harm. There is preliminary support that MACT could be an acceptable and effective intervention in patients with personality disorder and substance misuse.

The aims of this review were to explore the effectiveness and patient and provider acceptability of telepsychiatry consultations in intellectual disability, contrasting this with direct face-to-face consultations and proposing avenues for further research and innovation. Computerised searches of databases including AMED and EMBASE were conducted.

Four USA studies of intellectual disability telepsychiatry services have been reported. The majority (75%) focused on children with intellectual disability. Sample sizes ranged from 38 to 900 participants, with follow-up from 1 to 6 years. Outcome measures varied considerably and included cost savings to patients and healthcare providers, patient and carer satisfaction and new diagnoses.

The innovations summarised suggest a requirement to further explore telepsychiatry models. Despite some promising outcomes, there is a relative dearth in the existing literature. Further studies in other healthcare systems are required before concluding that telepsychiatry in intellectual disability is the best approach for providing psychiatric services to this population.

None.

To canvass the opinions of psychiatrists working in forensic settings on the recent proposals relating to dangerous people with severe personality disorder (DSPD). Psychiatrists from secure settings were invited to a series of meetings. A questionnaire was circulated and the discussions recorded.

Opinion remains divided over diagnosis, treatability and assessment of risk in personality disorders. The medicalisation of DSPD to allow indeterminate detention in unconvicted cases is unacceptable to the majority (75%). There is no consensus on the Government proposals relating to DSPD. Only a minority (20%) of psychiatrists would work in a new specialist service, which has significant implications for service development.

The involvement of psychiatrists in preventative detention solely for public protection requires greater discussion.

To ascertain the efficacy of custody health screening for mental disorders. We assessed a sample of detainees for the presence of mental disorders and the need for an appropriate adult. The assessments were carried out using pragmatic interviews and examinations supported by structured tools. Where possible, we attributed a probable clinical diagnosis based on the information available to us. The need for an appropriate adult was judged based on this information and capacity assessments.

Existing screening procedures missed a quarter of cases of severe mental illness and moderate depression; they also failed to detect about a half of those at risk of alcohol withdrawal and 70% of those at risk of withdrawal from crack cocaine. The need for an appropriate adult was not recognised in more than half of cases.

Consideration should be given to modifying police screening procedures for mental and associated disorders so that detainees receive the appropriate attention.