To review the efficacy and safety of melatonin in the treatment of insomnia in children and adolescents, through a Medline search covering the years 1966 to November 2003.

Five placebo-controlled studies and several case series were identified. Melatonin reduces sleep latency, but does not consistently improve other aspects of sleep disturbance. Safety, particularly in the medium- and long-term, is poorly evaluated; short-term concerns include exacerbation of epilepsy and asthma.

Melatonin might be effective in the short-term treatment of sleep onset insomnia. The optimal dose is unknown. It cannot currently be recommended for the treatment of other forms of sleep disturbance or for routine long-term use. Melatonin is not a licensed medicine in the UK.

This paper describes the process of setting up and the early results from a new liaison psychiatry service in primary care for people identified as frequent general practice attenders with long-term conditions or medically unexplained symptoms. Using a rapid evidence synthesis, we identified existing service models, mechanisms to identify and refer patients, and outcomes for the service. Considering this evidence, with local contingencies we defined options and resources. We agreed a model to set up a service in three diverse general practices. An evaluation explored the feasibility of the service and of collecting data for clinical, service and economic outcomes.

High levels of patient and staff satisfaction, and reductions in the utilisation of primary and secondary healthcare, with associated cost savings are reported.

A multidisciplinary liaison psychiatry service integrated in primary care is feasible and may be evaluated using routinely collected data.

A questionnaire was distributed to patients in a psychiatric hospital in Birmingham, UK, to identify the factors that affect their satisfaction with the ward round.

The questionnaire was completed by 42 patients (53% response rate). Waiting time was the only variable to be significantly correlated with total score of patient satisfaction. Regression analysis also identified diagnosis and patients meeting their consultant before the first ward round as significant predictors of patient satisfaction.

Reducing waiting time and ensuring that the consultant meets the patient before the first ward round would make a significant improvement to the in-patient experience, without causing much disruption to standard clinical practice.

The prevalence of errors in reference citations and use in the psychiatric literature has not been reported as it has in other scientific literature. Fifty references randomly selected from each of three psychiatric journals were examined for accuracy and appropriateness of use by validating them against the original sources.

A high prevalence of errors was found, the most common being minor errors in the accuracy of citations. Major citation errors, delayed access to two original articles and three could not be traced. Eight of the references had major errors with the appropriateness of use of their quotations.

Errors in accuracy of references impair the processes of research and evidence-based medicine, quotation errors could mislead clinicians into making wrong treatment decisions.

The aim of this study was to evaluate the predictive validity of the HCR–20 risk assessment instrument for the case-load of an inner-city community forensic team. File review and an interview with the keyworker for each patient were used to compile the information, and the author completed the HCR–20 for all patients. Cases were followed up for an average of 2.5 years to collect information on recidivism.

The risk profile for this sample was comparable to published North American studies. Patients who were subsequently charged with or convicted of violent offences all scored highly on the HCR–20.

The HCR–20 appears to be a useful instrument for stratifying risk within community forensic samples; this finding has implications for intensity of treatment and supervision. However, the data also suggest that services need to target criminogenic variables more effectively.

At a London teaching hospital, the existing off-site consultation model psychiatric liaison service for older people was replaced with an on-site liaison model service in December 2000. Several indicators of the functioning of the service were audited using identical methods before and after this change.

The case-load increased by 50%, but the liaison psychiatrists were more satisfied with the appropriateness of referrals. The case mix did not change. The new service achieved target waiting times more consistently, particularly for urgent referrals. Referring teams were more satisfied with the speed of response, while the new service maintained the salience and clarity of advice.

Findings are on the whole favourable, and support the wider introduction of specialist old-age liaison psychiatric services.

In 1999, child and adolescent mental health (CAMH) in-patient provision was unevenly distributed across England. A repeat of a1999 bed count survey was conducted in 2006 to determine whether change had occurred in response to government policy.

Total bed numbers in England were found to have increased by 284; 69% of the increase is due to the independent sector, whose market share has risen from 25% in 1999 to 36% in 2006. Regions with the highest number of beds in 1999 have increased bed numbers more than areas with the lowest number of beds in1999 (8.3 v. 3.6 beds per million population). In units that admit only children under the age of 14, there has been a 30% reduction in beds available (123 to 86).

Inequity in provision of CAMH inpatient services has increased despite government policy to the contrary. We speculate that this might be partly due to fragmented and local commissioning, and the effects of market forces operating as a result of increasing privatisation.

We report the results of a clinical audit of patients' reactions to two types of talking therapy groups facilitated by assistant psychologists and psychology graduates on three acute wards. Patients' experiences of problem-solving and interpersonal group formats were explored via focus groups and structured interviews with 29 group participants.

Both group formats generated high satisfaction ratings, with benefits related mostly to generic factors.

Adequately trained and supported assistant psychologists and psychology graduates can provide supportive talking groups that patients find helpful.

We aimed to examine the burden of mental disorders in Pakistan over the past three decades. We used the crude data of disability-adjusted life-years (DALYs) obtained from the Global Burden of Disease Study database (1990–2019) to represent burden. Data were retrieved on 26 January 2021. Data for adults of reproductive age (aged 15–49 years) were analysed to discuss and interpret the disease burden. An analysis was conducted on total DALYs separately for the genders for ten mental disorders reported in Pakistan.

DALYs increased drastically with the onset of reproductive age. Depressive disorder was the most reported mental disorder, contributing 3.13% (95% CI 2.25–4.24) of total DALYs, and varied significantly between genders: females 3.89% (95% CI 2.73–5.29) versus males 2.37% (95% CI 1.62–3.25).

A nationwide high-quality epidemiological surveillance system should be implemented to monitor mental disorders and offer culturally appropriate preventive services.

To evaluate a psychosocial intervention for patients treated with antipsychotics with body mass index (BMI) > 25. A total of 44 patients (mean age (s.e.) 37.6 (1.2); 28 female, 16 male) received dietary and exercise advice with motivational interviewing. Weight and BMI were measured at baseline and monthly thereafter. Patients were offered weight monitoring for 1 year.

Overall mean weight loss was 3.1 kg (mean 3.22%). Modal (range) weight change was 74.2 (719.2 kg to +8.7 kg).

Overall weight loss was not significant after 355.7 (32.5) (mean, s.e.) days. Determinants of response remain unclear. Avoiding weight gain in the first instance is critical. Further research will explore determinants of antipsychotic-induced weight gain and prevention strategies.