We report two cases from a study of Oxford hostels for the homeless of patients who were suffering from schizophrenia and are not receiving medication. After compulsory admission to hospital and treatment both showed a dramatic improvement in behaviour which was confirmed by a standardised rating scale. We discuss how hostels for the homeless have become both asylums and traps for those who suffer from schizophrenia and conclude that doctors should not under-estimate the potential benefit of anti-psychotic drug therapy even in homeless people with chronic psychosis.

The care programme approach was developed to ensure that patients in the community receive the health and social care they need. It pre-empted the philosophy and practice of care management and can form the core. There are several strengths to this approach in that it permits a response to individual needs that may change over a period of time, and co-ordinates the contribution of all care agencies to make effective use of the available resources.

Following the publication by the National Institute for Mental Health in England (NIMHE) of Personality Disorder: No Longer A Diagnosis of Exclusion (National Institute for Mental Health in England, 2003), it is perhaps surprising that so soon after there have been threats to the survival of some of the small number of existing specialist personality disorder services to which it refers. Indeed, one of the few in-patient units specialising in such disorders (Webb House in Crewe) closed in July 2004. Such closures or threats argue for closer collaboration in planning between the relevant secondary and tertiary services and also between the Department of Health, the NIMHE and local National Health Service commissioners. Not safeguarding existing tertiary specialist services, at a time of increasing awareness of the needs of patients with personality disorders, may be short-sighted.

Services for adolescents who overdose remain variable in the UK despite College guidelines. The problem is significant in terms of the demand placed on services, the level of distress it represents and the high eventual mortality rate. This study was undertaken to gain an understanding of the local picture with a view to improving service provision. The study revealed a high level of psychiatric morbidity, considerable drug and alcohol misuse and paracetamol as the most commonly taken substance. The findings supported Hawton's classification into three distinct groups, confirming it as a simple but useful system. This may provide a means of screening adolescents who overdose to improve service delivery to those most in need within the resources available. The possible role of the primary child and adolescent mental health worker is discussed.

This article presents three case studies of patients that a child and adolescent mental health service (CAMHS) have supported and its purpose is to encourage discussion of two key learning points. The first of these is the utility of developmental trauma as an approach for children with mental health presentations. The second centres on the importance of multi-agency working when working with young people, principally those within the UK's local authority care system (‘looked after children’), who have had traumatic experiences in order to enhance positive outcomes. We also want to encourage consideration of the implications of developmental trauma for current core CAMHS therapeutic models in an attempt to reach beyond the often held narrative that the trauma formulation implies there is ‘just trauma, no mental illness’.

Akathisia is a distressing movement disorder associated with neuroleptic medication. Patients complain of a feeling of inner restlessness (Barnes, 1989). The characteristic signs include constant moving when seated, rocking from foot to foot and pacing (Adler et al, 1989). Neuroleptic-induced akathisia (NIA) is usually an acute reaction, but a chronic akathisia can occur after prolonged treatment with neuroleptics (Fleischhacker et al, 1990). It has been suggested that chronic NIA is related to tardive dyskinesia, and that like tardive dyskinesia it is difficult to treat (Blaisdell, 1994). Reducing the neuroleptic dose may ease the symptoms (Barnes, 1989). Other options include using an atypical neuroleptic, which may cause lower rates of akathisia (Poyurovsky et al, 1999). Biochemical and pharmacological evidence has indicated the importance of serotonin in controlling movement (Bersani et al, 1986). Serotonin antagonists, particularly mianserin, ritanserin and cyproheptadine, have been used to treat NIA. This article reviews the published trials and case reports retrieved by a Medline search from January 1985 to August 1999.

There is growing interest in this country in developing training programmes suitable for overseas psychiatrists. The motive is partly one of self-interest. The implementation of current Government policy means that many departments will look to overseas visitors to fill their registrar positions in excess of their career registrar allocation.