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.

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.

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.

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.

To compare attitudes towards mental disorders in professionals working in mental health and professionals working in different areas of medicine. Levels of emotional empathy in both groups were also investigated. In total, 58 mental healthcare professionals and 60 non-mental healthcare professionals completed our attitudes towards mental disorders questionnaire and Balanced Emotional Empathy Scale.

The results reveal generally positive attitudes towards people with mental disorders in both groups. Non-mental healthcare professionals regarded people with a mental disorder as significantly more dangerous and unpredictable than did mental healthcare professionals. There was no statistically significant difference in emotional empathy between the two groups. Both groups cited illicit drug use as one of the most significant causes of mental disorder.

Mental healthcare professionals and non-mental healthcare professionals show broadly similar attitudes and a similar degree of empathy towards people with a mental disorder. However, non-mental healthcare professionals regard people with mental health problems as significantly more dangerous and unpredictable. There is scope for further research including examining the effects of educational interventions.

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.

New collaborative care models with an emphasis on primary care are required for long-term management of patients with severe and enduring mental illness (SMI). We conducted a descriptive evaluation of clinical outcomes of the first 3 years of a novel enhanced primary care (EPC) service. Data from 2818 patients and staff survey results were analysed.

2310 patients were discharged to EPC (508 not assessed as clinically suitable or patients/general practitioners declined the transfer); mean length of stay with secondary care service of the cohort was 9.8 years (range 0–24). 717 patients (31%) have been discharged to primary care only out of the EPC services and 233 patients (10%) have been transferred back to secondary care. Patient and staff satisfaction with the new EPC model was high. No severe untoward incidents were recorded.

The data suggest that EPC can be safely provided for a significant proportion of patients with SMI, who traditionally received long-term secondary care support. The novel EPC model can be utilised as a template for the provision of cost-effective, recovery-oriented and non-stigmatising care in the community.

To gather opinion from trainees across England about their current experiences and future career plans. This was done via an internet-based survey.

Out of the 359 responses we received, 65.8% of trainees planned to stay in psychiatry until retirement. Trainees felt several issues were problematic, including the attitude of other specialties towards psychiatry, perceived substandard treatment of psychiatric patients by other specialties and implications of New Ways of Working.

Despite there being many areas of training respondents were happy with, if attrition is to be minimised, issues such as how psychiatric trainees integrate with the other medical specialties and how the role of doctors in the specialty is perceived need to be addressed.

To establish prevalence of domestic violence among female psychiatric patients, including risk factors, health professional attention and acceptability of routine enquiry. Participants were 70 adult women in an inner-city community mental health team who received questionnaire and case-note review. Main outcome measures were: lifetime/point prevalence of domestic violence; attitudes to routine enquiry; past disclosure and recording in psychiatric records; clinical and demographic risk factors.

Lifetime prevalence was 60% for physical violence from partners, 27% during pregnancy and 40% receiving injuries. Point prevalence was not reported, as an insufficient number of participants were currently in a relationship. As many as 82% regarded routine enquiry as acceptable, but only 24% had ever been questioned. Logistic regression analysis showed prediction by presence of children, previous overdose, and experience of sexual abuse.

Domestic violence in female psychiatric patients is common but undetected. Enquiry should be routine, but would require staff training.

To identify the prevalence and patterns of substance misuse in patients with schizophrenia in a catchment population in Dublin, and to compare this with that of a control group from general practice. Ninety-nine patients and 75 controls were interviewed using a semi-structured technique. Urine samples were obtained from all patients and controls were analysed for illicit substances.

Prevalence of illicit substance and alcohol misuse was similar among patients (illicit substances, 45%; alcohol, 33%) and controls (illicit substances, 43%; alcohol, 25%). Patterns of substance misuse were similar, apart from ecstasy, which was used more commonly by controls. Discrepancies were found between histories of drug use and urinalysis.

Illicit substance misuse in patients with schizophrenia may mirror usage in the general population, rates of misuse reflecting cultural factors rather than illness and patterns of misuse reflecting geographical variations in the availability of drugs. A combination of screening methods is more effective than the use of a single source of information.

We conducted a telephone survey of medium secure units in England and Wales to determine the distribution of women patients.

The survey identified 1836 medium secure beds, housing 342 women patients. Women in the NHS were housed primarily in mixed-gender units (170 women, 94%). Most NHS beds in single-gender units were for men (56 beds), whereas most private sector beds in single-gender units were for women (79 beds).

Increased awareness of the often inappropriateness of services for women in mixed-gender units has led to units deciding not to admit women patients and, inadvertently, more single-gender beds for men in NHS units than for women. The NHS units have to rely on private sector units to provide beds in single-gender units for women, perhaps at the expense of effective continuity of care.