Individuals with autism often have complex needs. In this paper, we attempt to establish the prevalence rates of other major psychiatric illnesses in learning disabled adults diagnosed with autism and analyse the use of medication in these individuals. A total of 571 clients with learning disability were screened for autistic spectrum disorder, identifying 164 individuals for study. Psychiatric and medical diagnoses were also reviewed.

Of the individuals with autism, 35% had another comorbid psychiatric disorder. An overall prevalence rate of 10% for hypothyroidism was also identified and 35% of people with autism and no other psychiatric diagnosis were on neuroleptics.

Planning of services for autism will have to take into account the high comorbidity of autism and other psychiatric conditions. Individuals with autism will also benefit from close monitoring of mental state and the development of hypothyroidism.

To explore the impact of diagnosis on people who experience psychosis. Eight participants were interviewed about the impact that diagnosis had on them.

The research found that the impact of diagnosis can involve both positive and negative elements. It can be a ‘means of access’ as well as a ‘cause of disempowerment’. It can help by ‘naming the problem’ and hinder by ‘labelling the person’. It is a ‘cause of social exclusion’ for all, but despite this service users can be successful in ‘achieving social inclusion’.

The findings have implications for how diagnosis is imparted by psychiatrists if they are to help to facilitate recovery and social inclusion.

Ward staff were asked to rate whether in-patients with a diagnosis of functional psychotic illness also met criteria for a diagnosis of alcohol or drug misuse or dependence during the preceding 6 months. Those who demonstrated such evidence were then asked to report the nature and extent of their substance use and whether they continued to use as in-patients.

264 in-patients with psychotic illness were screened for evidence of recent or current alcohol or drug misuse. According to staff reports, 127 (48.9%) met the criteria for substance misuse or dependence. The mean age of those with ‘dual diagnosis' was 34.7 years and 72% were male. Eighty-three (83%) of those with a history of current or recent alcohol or drug misuse reported that they had continued to use alcohol and/or illicit drugs in the in-patient wards during their current admission.

It appears difficult to prevent in-patients with drug or alcohol misuse problems from continuing to use substances in hospital. Further consideration and investigation of how best to manage this group is therefore required.

Despite considerable knowledge of outcomes for patients who complete treatment for eating disorders, less is known about earlier stages in the treatment journey. This study aimed to map the efficiency of the anticipated patient journey along care pathways. Referrals to specialist eating disorder services (n=1887) were tracked through the process of referral, assessment, treatment and discharge.

The patient mortality rate was low. However, there were serious problems of attrition throughout the care pathways. of the original referrals where a meaningful conclusion could be reached, in approximately 35% the person was never seen, only half entered treatment and only a quarter reached the end of treatment.

This study demonstrates considerable inefficiency of resource utilisation. Suggestions are made for reducing this inefficiency, to allow more patients the opportunity of evidence-based care.

The aim of the study was to get an estimate of oral health needs of in-patients on acute general adult wards in an inner-city psychiatric unit. Information was collected by means of a cross-sectional survey with patient interviews and a brief oral examination.

A significant majority of patients had carious teeth, inflammation of gums and oral plaque. A majority of patients complained of pain during the preceding 3 months and problems with teeth.

Oral health of patients admitted to an acute psychiatric unit is worse than compared to the general population. There appears to be a need for basic dental health education and easy access to dental care on psychiatric wards.

We aimed to evaluate the availability and nature of services for people affected by personality disorder in England by conducting a survey of English National Health Service (NHS) mental health trusts and independent organisations.

In England, 84% of organisations reported having at least one dedicated personality disorder service. This represents a fivefold increase compared with a 2002 survey. However, only 55% of organisations reported that patients had equal access across localities to these dedicated services. Dedicated services commonly had good levels of service use and carer involvement, and engagement in education, research and training. However, a wider multidisciplinary team and a greater number of biopsychosocial interventions were available through generic services.

There has been a substantial increase in service provision for people affected by personality disorder, but continued variability in the availability of services is apparent and it remains unclear whether quality of care has improved.

To establish the views of child and adolescent psychiatrists (n = 52) regarding the conceptual and empirical validity, clinical utility and acceptability of the diagnosis of borderline personality disorder in child and adolescent populations. A questionnaire survey was carried out.

The child and adolescent psychiatrists' perception of the validity of borderline personality disorder for adult populations was relatively high (82% felt it to be valid). Significantly fewer of those considered borderline personality disorder to be valid for adolescent populations (37%). Strikingly different results were obtained when the questions related to child (<12 years) populations (2%).

Given the views expressed by these consultant child and adolescent psychiatrists, it would seem appropriate to approach with caution suggestions that the borderline personality disorder category should have extended use with adolescent and child populations.

To evaluate the physical health and health risk factors in long-stay psychiatric patients in a high secure psychiatric hospital. A cross-sectional survey of consenting patients was undertaken using a semi-structured questionnaire, a brief physical examination and review of patient case notes. A comparison was made with data collected on admission and held on the Special Hospitals' Case Register.

Main findings were: a mean increase in weight since admission, in men of 10.62 kg and in women of 12.74 kg; high rates of smoking, obesity and large waist size; 54% of patients had one or more health problems.

The study's profile of the physical health of psychiatric in-patients indicates the need for health promotion initiatives in such hospitals and the need for primary care services.

Although financial incentives to improve treatment adherence have been found effective in various medical specialties, there are few systematic data on their use, ethical background and effectiveness in psychiatry. We explored the practice of and possible ethical problems associated with direct financial incentives to improve adherence in assertive outreach teams in England. We also report clinical observations of a money for medication scheme with five assertive outreach patients in East London.

None of the assertive outreach teams that responded to the survey (response rate 47%) uses financial incentives. Attitudes of team managers towards the practice were mostly negative, often regarding it as unethical. Specific concerns were related to possible coercion and a negative impact on the therapeutic relationship. Out of five patients studied, four accepted the offer of money and had improved adherence; three remained without hospital admission since entering the scheme.

Money for medication might be a non-coercive and effective option to achieve medication adherence in otherwise non-adherent assertive outreach patients. However, ethical issues need further exploration and controlled trials are required to establish the effectiveness.

To dissect duration of untreated psychosis (DUP) into three components: help-seeking delay, referral delay and delay in mental health services, all mental health services in a defined geographical region were screened over a period of 1 year. All cases of first-episode psychosis without a primary mood disorder were identified (n=55).

The median delay within secondary services was over seven times the delay in the referral pathway. The mean delay in mental health services accounted for 35% of overall DUP.

Intervention is required in secondary as well as primary care services if DUP is to be reduced.

This cross-sectional study investigated the evolution of intentions among medical students to pursue a career in psychiatry and the factors that might discourage them from becoming a psychiatrist. A questionnaire survey was sent to medical students in years 1–5 at Aberdeen University.

From 918 students, 467 (51%) returned useable responses. Proportions of students across the 5-year groups who definitely or probably intended to become psychiatrists remained fairly stable at 4–7%. In their final year, psychiatry remained a possible career option for a further 17% of students. The most potent discouraging factor was the perception of poor prognoses among psychiatric patients. Perceptions of a lack of scientific/evidence base reduced enthusiasm for becoming a psychiatrist. Issues relating to the prestige of the specialty were also important.

If recruitment to the specialty is to improve, these negative perceptions among students should be addressed by their teachers and more widely within psychiatry.

Crisis resolution and home treatment teams (variously abbreviated to CRTs, CRHTTs, HTTs) were introduced to reduce the number and duration of in-patient admissions and better manage individuals in crisis. Despite their ubiquity, their evidence base is challengeable. This systematic review explored whether CRTs: (a) affected voluntary and compulsory admissions; (b) treat particular patient groups; (c) are cost-effective; and (d) provide care patients value.

Crisis resolution teams appear effective in reducing admissions, although data are mixed and other factors have also influenced this. Compulsory admissions may have increased, but evidence that CRTs are causally related is inconclusive. There are few clinical differences between ‘gate-kept’ patients admitted and those not. Crisis resolution teams are cheaper than in-patient care and, overall, patients are satisfied with CRT care.

High-quality evidence for CRTs is scarce, although they appear to contribute to reducing admissions. Patient-relevant psychosocial and longitudinal outcomes are under-explored.