To explore experiences of psychiatrists considering medication for patients with personality disorder by analysis of transcribed, semi-structured interviews with consultants.

Themes show important relational processes in which not prescribing is expected to be experienced as uncaring rejection, and psychiatrists felt helpless and inadequate as doctors when unable to relieve symptoms by prescribing. Discontinuity in doctor–patient relationships compounds these problems.

Problems arise from: (a) the psychopathology creating powerful relational effects in consultation; (b) the lack of effective treatments, both actual and secondary to under-resourcing and neglect of non-pharmaceutical interventions; and (c) the professionally constructed role of psychiatrists prioritising healing and cure through provision of technological interventions for specific diagnoses. There is a need for more treatments and services for patients with personality disorder; more support and training for psychiatrists in the relational complexities of prescribing; and a rethink of the trend for psychiatrists to be seen primarily as prescribers.

To describe a new open access community service for people with personality disorder and to explore interim service utilisation and outcomes. Routine data were analysed together with those from a cross-sectional survey.

During the first 16 months of the service, 171 people attended, of whom 142 (83.0%) returned on at least one other occasion. The median number of attendances was seven (IQR = 3.0–22.0). Over 90% of responders to the survey met criteria for ‘probable personality disorder’ and levels of social dysfunction were high. Presentations to emergency services, contacts with other services and in-patient admissions were reduced. Social functioning improved.

This service attracted a large number of people with significant health and social problems. Use of the service was associated with improved social functioning and reduced use of other services.

Neuroleptic medication is often used in excess of the BNF maximum. The purpose of this study was to examine the relationship of neuroleptic dose to patient, prescriber and environmental factors, by using a cross sectional ‘snapshot’ study of psychiatric in-patient prescriptions combined with a retrospective case note survey.

It was found that certain consultants prescribe higher doses of neuroleptics than others. Patients with a history of aggression had a nine and a half times higher chance of being prescribed higher doses of neuroleptics. Patients with a greater than 5-year history of neuroleptic prescription received higher doses.

High neuroleptic prescription is related more to patients' past reputation and prescriber differences than to patients' current behaviour.

A questionnaire was sent to all 55 community child and adolescent psychiatrists working in the West Midlands to examine the prescribing practices of community child psychiatrists, because most previous studies have included prescribing data from specialist (tier 4) services.

The survey had a good response rate (87%). The vast majority of child psychiatrists were prescribing stimulants and antidepressants, and over half were prescribing antipsychotics and melatonin. At least half of the consultants would consider prescribing an antipsychotic for the treatment of aggressive behaviour. One-third of consultants cited pressure on services as a reason for prescribing medication.

Community child psychiatrists were prescribing more medication than expected, which may have a considerable impact on referral rates to adult services in the future. It is concerning that the increased use of medication may be a reflection of pressure on services.

An audit project was carried out in a mental health trust in North-West London on two successive years to determine the average case-load size of defined severe mental illness for each professional discipline.

The average case-load for non-consultants varied from 16 (for occupational therapists) through to 98 patients (for senior house officers). Community psychiatric nurses had an average case-load of 21 and consultants had an estimated average case-load of between 185 and 317 patients. The proportion of patients with severe mental illness ranged from 49% to 67%.

The case-loads of consultants in community health teams are too large to exercise the statutory duties of a responsible medical officer and, therefore, need revision.

Community treatment orders (CTOs) are increasingly embedded into UK practice and their use continues to rise. However, they remain highly controversial. We surveyed psychiatrists to establish their experiences and current opinions of using CTOs and to compare findings with our previous survey conducted in 2010.

The opinions of psychiatrists in the UK have not changed since 2010 in spite of recent evidence questioning the effectiveness of CTOs. Clinical factors (the need for engagement and treatment adherence, and the achievement of adherence and improved insight) remain the most important considerations in initiating and discharging a CTO.

Given the accumulating evidence from research and clinical practice that CTOs do not improve outcomes, it is concerning that psychiatrists' opinions have not altered in response, particularly given the implications for patient care.

The Health of the Nation Outcome Scale for Acquired Brain Injury (HoNOS–ABI) is a relatively new outcome measure designed to assess the neuropsychiatric sequelae of brain damage. This study investigated the interrater reliability of this scale. Fifty patients with traumatic brain injury receiving rehabilitation were each rated twice on the HoNOS–ABI, by two different raters. There were 24 raters in total.

Weighted kappa values ranged from 0.43 to 0.84 and intraclass correlation coefficients from 0.58 to 0.97 for the ten items assessed. This indicated that agreement was moderate to substantial for all items.

The scales consistently measured the items of interest across different raters. This indicates that HoNOS–ABI is a reliable outcome measure when applied by different raters in routine clinical practice.

To develop a child and adolescent mental health service in a low-income country. This was a collaborative effort involving governmental and non-governmental organisations in the UK and Pakistan, where a training clinic was established.

We assessed and treated 169 children and adolescents. A team of mental health professionals was trained, including one consultant psychiatrist; the consultant psychiatrist is now leading the clinic. Links were further developed with healthcare, social care and educational organisations, as well as efforts made to engage the public in relation to child and adolescent mental health.

Our development highlights a model of research collaboration and service development which may be sustainable in low-income settings. Such initiatives need support from a variety of organisations. There is a need to consider whether there should be a formal funding mechanism to support the Royal College of Psychiatrists Senior Volunteer Programme.

To assess the factors that affect the clinical use of advanced care planning and palliative care interventions in patients with dementia. A literature search of Medline, Embase and PsycINFO was performed to identify themes in advanced care planning and palliative care in dementia.

In total, 64 articles were found, including 12 reviews, and three key areas emerged: barriers to advanced care planning, raising awareness and fostering communication between professionals and patients, and disease-specific interventions.

Most of the studies analysed were carried out in the USA or Continental Europe. This narrative review aims to help guide future primary research, systematic reviews and service development in the UK.

Radically open dialectical behaviour therapy (RO DBT) is a transdiagnostic treatment designed to address disorders associated with overcontrol, including autism spectrum disorders (ASD). To date, no studies have reported on the effectiveness of RO DBT for people with ASD. Forty-eight patients were referred to a RO DBT programme, of whom 23 had a diagnosis of ASD. Outcome was measured using the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE) and the Questionnaire about the Process of Recovery.

The intervention was effective, with a medium effect size of 0.53 for improvement in CORE global distress. End-point CORE global distress score was predicted from initial severity and a diagnosis of ASD. Participants with a diagnosis of ASD who completed the therapy had significantly better outcomes than completing participants without an ASD diagnosis.

These findings provide preliminary support for RO DBT as an effective intervention for ASD in routine settings.