In 2006, staff in child and adolescent mental health services (CAMHS) in Lincolnshire, UK, felt that cases were becoming increasingly complex. The Pearce Case Complexity Scale (PCCS) and a staff opinions questionnaire were used to measure subjective and objective changes in case complexity in a relatively stable CAMHS service over a 10-year period from 1996 to 2006, with data examined between 2008 and 2010.

Clinicians reported an increase in case complexity over time. However, the PCCS did not show a significant change in the decade studied.

Staff anxiety could be a determinant of judgements they make about case complexity in CAMHS.

To assess the competence of psychiatry trainees in identifying major abnormalities in a 12-lead electrocardiogram (ECG). This was a three-stage prospective study. In stage 1, selected ECG traces were presented to the trainees. They were then asked to comment on any abnormalities of note on the ECG traces. In stage 2, an ECG e-book was made available to the trainees and the survey repeated. In stage 3, ECG workshop sessions were introduced in the mandatory teaching programme and the survey was repeated.

The number of correct responses after the introduction of the workshops were significantly more when compared with correct responses in stage 2 (P = 0.0002), and stage 1 (P = 0.0091). When compared with stage 1, the correct responses in stage 2 actually showed deterioration (P = 0.0284).

Our study not only shows that providing access to an e-book is not enough to improve these skills, it also shows that ECG refresher sessions improved the diagnostic accuracy markedly.

Dialectical behaviour therapy (DBT) is associated with particularly high drop-out rates in the National Health Service (NHS). This paper seeks to investigate the characteristics of patients with borderline personality disorder dropping out from DBT and the role of care coordination in this phenomenon. Data for the 102 patients receiving DBT in east London, 58% of whom had dropped out of treatment prematurely, were analysed.

In a multivariable analysis, a history of care coordination was the only variable significantly correlated with drop out: 88% of patients with a history of care coordination dropped out prematurely compared with 52% of patients without such history.

The experience of comprehensive care within the care programme approach, particularly care coordination at the start of DBT, affects the retention of patients in DBT. Further qualitative research is required to understand how care coordination and DBT drop out are related, which could lead to changes in how the therapy is delivered in the UK and influence decisions regarding the use of care coordination with patients with borderline personality disorder.

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.

To examine the association between the use of paroxetine during pregnancy and the risk of cardiovascular defects in the newborn. A systematic review of nine electronic databases was carried out and bibliographies were hand-searched for other relevant articles. Inclusion criteria for studies were the use of selective serotonin reuptake inhibitors in the first trimester of pregnancy, with separate data available for paroxetine and cardiovascular defects in newborn babies. A random-effect model was used to combine the data.

A total of 11 studies were included in the analysis, concerning 4515 offspring who were exposed to paroxetine in the first trimester and 1 469 302 controls. In pooled analysis, paroxetine in the first trimester of pregnancy was slightly, but significantly, associated with a risk of cardiovascular malformations in the offspring (relative risk= 1.25, 95% CI 1.01–1.54). Separate analyses of case-control and cohort studies made this difference non-significant.

This meta-analysis supports current guidelines advising not to use paroxetine in early pregnancy.

To assess the usefulness of the electronic patient record, we used the search engine Clinical Record Interactive Search (CRIS) to scan all acute admissions during 2008 for possible substance use disorders. In addition, screening interviews were undertaken with 75 in-patients, and documentation in their files was compared with results of screening interviews.

Of 839 acute admissions during 2008, 47% of males and 29% of females had reference to a substance misuse problem in their file. Documentation was unsystematic and inconsistent and mostly occurred in progress notes rather than in structured questionnaires. Screening interviews and manual review of files of 75 current in-patients confirmed that substance use disorders were common, but poorly documented.

The study highlights the power of search engines in scanning electronic clinical records, but also identified the limitations of unsystematic documentation in research and practice. Mental health staff were reluctant to diagnose or rate severity of substance misuse problems.

We examined the impact of implementing a new Acute Mental Health Emergency Assessment Protocol (AMHEAP) on joint psychiatric assessments out of hours within Forth Valley, Scotland, over the course of 4 calendar months. The protocol states that assessments should be carried out by a junior doctor and a registered, qualified mental health nurse. The impact measures were taken as admission rates and experience of the doctor in training.

In the 4 months that were examined (1 June–30 September 2011), 79.5% of out-of-hours emergency assessments were performed jointly. Admission rates were significantly decreased (P<0.001) compared with a similar period in 2008, before the AMHEAP protocol was developed. Most junior doctors valued the experience of joint assessment.

Joint assessment can enhance patient experience, reduce hospital admission, and provide a learning opportunity for junior doctors in emergency psychiatric assessments. However, it represents a move away from the doctor as sole decision maker.

To evaluate patient awareness of the mental health tribunal and identify any association between capacity to request a tribunal and frequency of completed hearings. A cohort of detained patients within a secure hospital were assessed and data for past tribunals evaluated by presence of capacity and mode of application.

Of the 65 patients evaluated, 78% were aware of the tribunal's power to discharge, 14% were aware of its power to recommend leave and 4% were aware of its power to recommend transfer; 12% lacked capacity to request a tribunal. Patients with capacity received more completed hearings per year than those without, both overall (0.58 v. 0.29 per year, P = 0.04) and by patient application (0.45 v. 0.12 per year, P = 0.03).

Hospital managers should ensure that all detained patients have regular assessments of their capacity to request a tribunal and that those who lack capacity are referred to the Secretary of State when it is considered that a tribunal would be in their best interests. Hospital managers should consider referring such cases to the Secretary of State every 12 months.

To illustrate the clinical benefit of polygraph testing for mentally disordered sex offenders at a high secure psychiatric hospital. It is a retrospective review of two patients' case notes and of interviews with clinicians. Post Conviction Sex Offender Testing (PSCOT) was used to assist these patients in making disclosures regarding their sexual history and to aid their treatment.

Post Conviction Sex Offender Testing was responsible for bringing about new disclosures relating to the patients' sexual histories and aiding their treatment progression to lower secure settings. New information was incorporated into the patients' treatment programmes and risk management plans. Post Conviction Sex Offender Testing also encouraged a more honest and effective participation in sex offender treatment programmes and allowed the evaluation of antilibidinal medication.

Post Conviction Sex Offender Testing should be more widely considered among mentally disordered sex offenders who have been challenging to treat, as it has the potential to aid their management and progression to lower-security settings.

The upsurge of cyberbullying is a frequent cause of emotional disturbance in children and young people. The situation is complicated by the fact that these interpersonal safety issues are actually generated by the peer group and in contexts that are difficult for adults to control. This article examines the effectiveness of common responses to cyberbullying.

Whatever the value of technological tools for tackling cyberbullying, we cannot avoid the fact that this is an interpersonal problem grounded in a social context.

Practitioners should build on existing knowledge about preventing and reducing face-to-face bullying while taking account of the distinctive nature of cyberbullying. Furthermore, it is essential to take account of the values that young people are learning in society and at school.

To document the number and type of adverse medication events in a psychiatric sector service. Significant new adverse events were collated by the author and team over 30 months. Intervention to prevent any adverse event was enacted as soon as any were noticed or anticipated.

Thirty-six significant events occurred including three deaths and nine near misses. Corrective action was taken immediately any adverse event occurred. Inadequate communication between various hospital clinics, general practitioner practices, psychiatric clinics and pharmacies was the biggest avoidable cause of adverse events.

Awareness of adverse drug events is essential in psychiatry. Clear, transparent pathways of prescribing are a key requirement to reduce avoidable adverse medication events. Psychopharmacology is a core module for psychiatric training.

To provide a picture of availability and equality of access to mental health services for older people prior to the Equality Act. In 2010, a questionnaire was sent to health commissioners in England, Scotland and Wales under a Freedom of Information request.

Overall, 132 (76%) replied. Of 11 services, 7 were either unavailable or did not provide equality of access to older people in more than a third of commissioning areas. When provided by specialist older people's mental health, services were more often considered to ensure equality.

Increasing need resulting from an ageing population is unlikely to be met in the face of current inequality. Inequality on the basis of age is the result of government policy and not the existence of specialist services for older people. Single age-inclusive services may create indirect age discrimination. Availability alone is insufficient to demonstrate equality of access. Monitoring the effects of legislation must take this into account.

This study utilised qualitative methods to explore medical students' experiences of a clinical attachment in psychiatry and examine the impact of these on career intentions. Fifteen 4th-year students from the University of Bristol were interviewed and their responses analysed.

Four key themes of role models, difference, stigma and career choice emerged from the analysis. Role models could be more influential than the specialty when choosing career options. Many students experienced psychiatry as being different to other specialties. For some this was a reason not to pursue psychiatry as a career but for others it was a positive aspect of the specialty. Stigma arose from a variety of sources, notably from medical students themselves.

These findings are relevant given the current recruitment problems in psychiatry and need to be considered in the planning and delivery of undergraduate medical education.