The objective of the study was to determine the level of involuntary treatment that mood disorder patients and their families wish in the event of a manic or hypomanic episode.

A survey was conducted within two self-help organizations during two conventions gathering over 500 patients, along with families and caregivers. A clinical vignette depicting an uncollaborative hypomanic patient beginning to endanger his professional and financial situation and to put undue stress upon his family was presented and followed by an eight-item questionnaire. The level of coercive treatment seen as appropriate was measured by visual analogue scales.

The 503 respondents disagreed partially with the statement that the patient should decide by himself about his hospitalization and partially favored some involuntary treatment over treatment refusal. There was no difference between patients, relatives and caregivers related to acceptance of coercive hospitalization and treatment. Respondents assigned a major role to treating teams and family members in decisions for coercive treatment.

Most respondents (including a majority of patients) support a moderate degree of coercive treatment in the event of a hypomanic or manic state. Surveys of opinions from concerned people could influence, practice, legislation and possibly advance directives that could be written by patients or patients organizations.

A series of eleven patients prescribed intramuscular clozapine at five UK sites is presented. Using routinely collected clinical data, we describe the use, efficacy and safety of this treatment modality.

We administered 188 doses of intramuscular clozapine to eight patients. The remaining three patients accepted oral medication. With the exception of minor injection site pain and nodules, side-effects were as expected with oral clozapine, and there were no serious untoward events. Nine patients were successfully established on oral clozapine with significant improvement in their clinical presentations.

Although a novel formulation in the UK, we have shown that intramuscular clozapine can be used safely and effectively when the oral route is initially refused.