To determine how often and why antipsychotic medicines are prescribed to people with dementia. A cross-sectional survey of all clinical records was conducted in one National Health Service mental health trust.

Of 946 people with dementia in the trust, 186 (20%) were prescribed an antipsychotic. Prevalence increased with the severity of dementia. The most common indication for initiating treatment was agitation/distress (70%), followed by verbal aggression (45%), psychotic symptoms (44%) and physical aggression (33%). The mean number of indications per patient was 2.6. In 58% of cases, the antipsychotic had been prescribed for more than a year, and a third of patients had not been reviewed in the past 6 months.

People with dementia who are prescribed antipsychotic drugs generally display a range of challenging behaviours, but most notably are distressed. Systems for ongoing clinical review need improvement.

Community compulsion via community compulsory treatment orders is used routinely in Scotland. We aimed to describe the common characteristics of individuals subject to community compulsion. We collected standardised information from a national database about individuals subject to community compulsion and compared them with people subject to hospital detention.

Analysis of 499 cases revealed that the majority of individuals subject to community compulsion had a psychotic illness, had a history of non-adherence to services and treatment, and were more likely than not to be in receipt of a long-acting injection of antipsychotic medication. Patients subject to community compulsion were clinically similar to patients subject to hospital-based treatment orders and usually were considered to pose a risk to other people.

Community compulsion has been widely adopted despite a relative lack of supporting scientific evidence. Our findings are similar to those of other related studies and highlight that individuals with a psychotic illness who are ambivalent about treatment and who pose a risk to self or others are likely to be considered for community compulsion.

To study intrusive phenomena relating to traumatic experiences in a community sample seeking treatment for substance use disorder and an in-patient sample from an addiction in-patient detoxification service in London. Perceived effect of drugs and drug use on traumatic intrusion and memory experiences was also analysed. The study was conducted using a semi-structured patient interview comprising a series of questionnaires.

The most frequently identified traumatic memories were those of traumatic bereavements. Substance use appears to have had the effect of dampening the memories for those with post-traumatic stress disorder (PTSD), and significantly more individuals reported that their memories were less vivid and less distressing before they ceased substance use.

The findings suggest that continued substance use could in part be motivated by its capacity to dampen distressing memories within the PTSD group. This should be addressed within a treatment plan of comorbid PTSD.

This study explores knowledge and uptake of the voting rights of adult in-patients in the 2010 UK general election. A clinician-completed survey was used.

Eligible to vote psychiatric adult in-patients were half as likely to register as the general population and half as likely to vote if registered. Nine out of ten of those unregistered cited a lack of knowledge of their eligibility to vote or of the registration process. Long-stay patients were particularly disenfranchised.

Many patients and staff remain unaware of the new rules which have given a greater proportion of in-patients the right to vote and have simplified the registration and voting processes. This information barrier may be addressed in future elections by providing timely written information to both patients and staff. Once registered, patients may need further support to overcome practical and psychological barriers, and cast their vote.

To select staff for a personality disorder service by exposing applicants to anticipated challenges. Applicants took part in a role play, an unstructured group with fellow applicants and numbers of the interviewing panel, and a panel interview. A service user representative was involved from the initial planning stage.

Multiple assessment methods enabled fine discrimination between applicants. Appointed staff said they felt the interviews were a valid test of required skills and have been well regarded by patients in the programme.

Selecting staff for a personality disorder service benefits from using multiple interview methods. The service user representative and role-play actor can contribute crucially by representing the patient's perspective. Key domains to assess include the applicant's psychological qualities, psychiatric skills and ability to work in a team.

Accumulating evidence suggest that psychiatrists may be at greater risk of being stalked compared with the general population. We used a self-administered questionnaire to survey psychiatrists in Ireland about their experiences, practices and attitudes regarding work-related stalking.

We found that 25.1% of psychiatrists in Ireland had been the subject of stalking behaviour at some point in their career. At the time of the survey, 5.5% of respondents were actively being stalked. The majority of the stalking occurred in the workplace and most of the perpetrators were patients. Most of the victims were unaware of guidelines or other supportive mechanisms in their workplace. Of those who reported their experiences to authorities, almost half were not satisfied with the support they received.

Stalking of psychiatrists is not uncommon. Employers should put in place supportive structures backed up by education and training to reduce the incidence, associated morbidity and other wider consequences of stalking.

To measure the take-up of formal crisis plans in a specialist home treatment team (HTT) serving an ethnically diverse urban population; and to implement a quality improvement programme and measure its impact on crisis plan completion. Two audits were completed of patients before and after the implementation of a quality improvement programme. Descriptive data are shown by ethnic group, by gender, and for people with multiple hospital admissions.

At baseline, 16.7% of patients at high risk of admission had an HTT crisis plan, compared with 26.7% of a comparison group. Only 23.1% of the crisis plans for patients with a history of frequent admission mentioned the prevention of future admissions. Crisis plan completion improved following the quality improvement programme, when 80.0% of discharges had an HTT crisis plan; of these, 73.0% mentioned admission prevention. In the follow-up audit, 22.7% of patients in the multiple admission group had been readmitted to hospital at least once. Crisis plan completion did not appear to differ by ethnic group or gender and did not appear to be related to hospital readmission.

Crisis plan completion improved with simple practical methods, but completion was unrelated to gender, ethnicity or later readmission.

The Security Needs Assessment Profile (SNAP) was developed to provide a detailed description of individual patient's security requirements in the then Trent Region of England. A national survey of secure units was undertaken to examine the content validity of the item structure of SNAP and revise the item definitions to reflect more broadly based clinical practice. A follow-up survey sought views on the usefulness of SNAP in clinical practice.

Thirty-five secure units from National Health Service and independent sector providers participated. No new security items were generated. All the item definitions were reviewed, many amended, and a small number revised extensively. Units' security profiles were rated on the original and revised instruments.

The revised SNAP has been shown to be generalisable across secure services in England; 92% of respondents agreed or strongly agreed that SNAP would be useful in providing a structured security needs assessment.

Patients known to learning disability services in two health boards in southeast Scotland were cross-matched with the patients tested at the Western General Hospital in Edinburgh. Those with a positive genetic diagnosis were identified. Semi-structured interviews were conducted with senior learning disability psychiatrists and clinical genetics consultants.

Of the 3323 patients with intellectual disability across both health boards, 41% have had genetic tests and 6% have an identified genetic abnormality as the cause for their intellectual disability. Of the 1349 patients who have been tested, a genetic abnormality was found in 14%. Psychiatrists named several benefits to genetic testing, but they also highlighted a number of non-medical reasons for not testing adults with intellectual disability.

Identifying genetic aetiology in intellectual disability has a number of benefits. Our study would indicate that genetic diagnoses are being missed due to a lack of genetic testing in this patient group. Adult learning disability services need to consider increasing genetic testing.

The HEALTH Passport is a tool to help patients make lifestyle changes to reduce the future burden of chronic disease. This study assesses the potential of this behaviour change strategy in psychiatric patients. We introduced 50 psychiatric in-patients to the HEALTH Passport and asked them to complete a semi-qualitative questionnaire. Results were compared with those of 100 controls.

Psychiatric in-patients are exposed to almost twice as many modifiable risk factors of chronic disease compared with controls. Although psychiatric in-patients are less motivated to address their risk factors, the HEALTH Passport could almost halve the proportion of psychiatric patients at high risk of chronic disease.

The low level of health literacy among psychiatric patients must be addressed to reduce their risk exposure. Potentially, the HEALTH Passport provides a cost-effective tool for this purpose.

To examine patients' perceptions of unmet needs during methadone maintenance treatment (MMT), and to explore the relationship between co-occurring benzodiazepine misuse and severity of needs. A cross-sectional survey was carried out at an MMT programme in Dublin, Ireland. All patients were invited to participate on a voluntary basis. Of the 191 eligible patients, 107 agreed to participate and completed the Camberwell Assessment of Need questionnaire.

Unmet needs for substance misuse treatments, daytime activities, socialisation, money management and psychological distress were high. Fifty-two respondents (49%) reported using non-prescribed benzodiazepines during the past month. Compared with non-users of benzodiazepines, benzodiazepine users reported higher ratings of total and unmet needs (P < 0.05). The number of days using benzodiazepines predicted the severity of needs.

The findings highlight the importance of addressing coexisting psychological needs, and further support enhancing treatment interventions for benzodiazepine misuse or dependence among patients on MMT.

To audit the quality of medical recommendations for detention under the Mental Health Act 1983, Section 2 and 3. The recommendations were tested against a gold standard based on the statutory criteria. Two cycles were completed, the first containing 214 recommendations, the second 202. Relevant education took place after the first cycle.

The percentage of medical recommendations containing clear statements of why each of the statutory criteria was met increased in the second cycle. It reached 87% for mental disorder; 87% for nature and/or degree; 75% for why community treatment was not possible; 64% for why detention was in the interests of health; 60% for safety; 55% for protection of others; and 70% why informal admission was not possible.

Doctors, scrutineers and approved mental health practitioners welcomed clear guidance about what is expected in a medical recommendation for detention and endorsed the gold standard described. Armed with a better understanding of what is expected and a template to follow, there was an improvement in the reasons given for detention.

To evaluate the suitability of 80 patients referred for assertive outreach treatment (AOT) and their treatment outcomes, by comparing clinical and social data during the treatment period with data before treatment began. To control for service development across the board, patients on ordinary community treatment were identified and matched to patients undergoing AOT for age, gender, clinical diagnosis and duration, and data acquired for the same time period as the patients on AOT. This was a retrospective mirror-image evaluation with contemporaneous controls.

The patients referred for AOT were more socially disadvantaged and had used more clinical resources than the control patients. Overall, AOT reduced resource uptake markedly following referral, while resource uptake by control patients during the same period remained static or increased; AOT, however, did not lessen most aspects of social disadvantage.

The advantages of AOT include much reduced use of services but not the resolving of social exclusion. Some ordinary community provision may fail to afford the quality of AOT and thus suffer by comparison. The demise of AOT may be premature in such services.

To assess stigmatising attitudes towards mental illness and psychiatric professionals experienced by UK liaison psychiatry staff. A questionnaire asked about the impact of these events on patient care and for suggestions for tackling stigma in the general hospital.

Out of 72 multidisciplinary respondents, over three-quarters had experienced stigmatising attitudes towards mental illness by general hospital colleagues at least monthly. Two-thirds reported instances where stigmatisation had an adverse impact on patient care, and over a quarter reported stigmatising attitudes towards mental health professionals. Suggestions for combating stigma included educational initiatives, clear clinical communication, and the provision of high-quality liaison services.

Liaison psychiatry is well placed to both recognise and combat stigma in the general hospital. This can help to ensure that patient care is comprehensive, safe and respectful.

Coping Through Football aims to improve well-being and reduce social isolation for younger people with severe mental illness in a deprived area of North East London. Interviews were conducted with 12 service users, 5 referrers and 2 coaches to obtain their views of the project's implications for health and well-being, quality of life and social/community relationships. A qualitative approach was used to derive themes from interview transcripts using some of the tools of grounded theory.

Themes included: identifying with past self; service with a difference: opening up the social world; safety; empowerment; and feeling good. Coping Through Football was seen by stakeholders as leading to increased well-being and social opportunities within a safe and understanding environment.

For many service users the football project played a key role in their recovery of personal and social roles. Social and community-based mental health projects benefit greatly from active community collaboration, in this case a professional football club and several non-statutory sport/leisure bodies.

To assess the impact on psychiatric in-patient bed use of a new personality disorder service that uses two psychoanalytical models: mentalisation-based treatment (MBT) and the service user network (SUN). The number of psychiatric bed days used by patients attending each of the three arms of the service model (SUN, 3-day MBT, 2-day MBT) was collated using the electronic patient records system. Bed use in the 6 months and 12 months before each patient started treatment was compared with bed use in the same periods after starting treatment.

Overall, statistical analysis revealed bed use to be significantly reduced by 6 months of treatment, and the reduction continued to prove significant at 12 months. Comparison between subgroups found no significant difference in bed use between patients attending the MBT programme and patients attending the SUN project at 6 months, but patients on the 3-day MBT programme exhibited a significantly greater reduction in bed use at 6 months compared with patients on the 2-day MBT programme.

Intervention had a statistically significant effect overall on reducing bed use, which we suggest is linked to an improvement in patients' functioning, and is maintained at 6 months and 12 months of treatment. The lacking difference between the SUN and MBT components of the model raises questions regarding the best allocation of resources and the longer-term effects on bed use, to be answered by further study.

The literature on the use of electroconvulsive therapy (ECT) in patients with an intellectual disability is scarce, despite a higher prevalence of psychiatric disorders than in the general adult population. We carried out a review of articles published before March 2010. All age ranges, severity of disability and diagnoses were included.

We found 72 case reports, a retrospective chart review study and other reviews, but no controlled studies. Most patients (79%) showed a positive outcome following ECT. Complications were seen only in 13% and there were no reports of cognitive decline. Many patients relapsed following ECT (32%) and the majority were maintained with medication at follow-up (71%).

Electroconvulsive therapy is a valuable treatment for this patient group and should be considered earlier as opposed to as a last resort. Obstacles to its use include diagnostic difficulties, ethical and legal issues, a lack of objective measurements and uncertainty about its safety in this population.

We assessed 92% (117/127) of the patients in our community mental health learning disability team using the Mental Health Clustering Tool (MHCT) to establish whether their needs could be captured sufficiently well to enable assignment to a care cluster for payment by results in mental health. We explored the characteristics of those assigned to Cluster 0 to identify how they differed from those who could be assigned to Clusters 1-21.

As expected, nearly half of the case-load (48%) could not be assigned to any cluster except Cluster 0, the variance cluster, which is used when the needs of patients cannot be captured by the current 21 care clusters but a service is, or will be, provided.

The MHCT in its current form does not adequately capture the needs of people with more severe intellectual disability. An integrated mental health and learning disability clustering tool is in development. This is expected to include new rating scales and new clusters, however until the development is completed and validated it will not be possible to implement payment by results in mental health in learning disability services.