Background: The principle that patients should be cared for under conditions of no greater security than is justified is well established and applies to patients cared for on psychiatric intensive care units.

Aims: This audit aimed to establish: (1) the characteristics of patients admitted to a PICU, (2) whether patients experienced delays in discharge to care in lower levels of security and (3) the characteristics of patients who experienced a delayed discharge.

Method: An audit survey of the case notes of patients discharged from an inner city PICU in 2005 to establish compliance with the standards described.

Results: Of 109 patients discharged from the PICU, 88 were included in the survey. 51.1% of patients experienced a delay in discharge from the PICU. The characteristics of the patients discharged from the PICU are described, and compared with those experiencing a delay in discharge.

Conclusions: Patients often experience a delay in discharge to clinically appropriate levels of security from a typical PICU. The source of referral of patients and diagnosis are associated with a delay in discharge. The findings warrant wider study.

Objectives: To study the frequency of use, indications and reported side-effects of antidepressants in the treatment of adult inpatients at a UK secure hospital.

Methods: Cross-sectional survey of the use of antidepressants for forensic rehabilitation patients, together with structured interviews with the treating psychiatrists.

Results: A total of 94 patients (40.7%) were prescribed antidepressants. The majority (68.9%) were prescribed SSRIs. Antidepressant usage was associated with female gender, depression and emotionally unstable personality disorder. Patients with learning disabilities and pervasive developmental disorders were less likely to be prescribed antidepressants than the rest. Only 10 patients (10.6%) had a formal diagnosis of depression, anxiety or obsessive compulsive disorder. For 67.0% of patients the plan was to continue with the antidepressant long-term. Although 83.0% of psychiatrists said they had asked about side-effects, few (14.9%) had asked about sexual side-effects and only 3.2% of patients were reported as having side-effects.

Conclusions: Long-term antidepressant usage in this population was common. The reported incidence of side-effects was very low and is likely to be much higher in reality. Psychiatrists should make regular inquiry about side-effects, including sexual side-effects when appropriate, as well as regularly reviewing the need for continuing treatment.

Psychiatric patients suffer high rates of mortality and morbidity. One of the major reasons for this is the high prevalence of physical health problems in psychiatric patients. Psychiatrists have tended to pay less attention to, and receive less training in, the management of the physical health of their patients with this role largely being left to general practitioners. Though there is an increasing awareness of long term physical morbidities in psychiatric patients, the literature on acute physical morbidity is sparse. In this article we aim to emphasise the importance of recognising serious physical illnesses that could arise in the acutely unwell psychiatric patient.

The scope of this article is not to provide a comprehensive list of physical complications and management strategies but to provide the psychiatrist with a conceptual framework to assist with the management of co-morbid physical and psychiatric illness.

Background: Psychiatric intensive care units (PICUs) initially developed in a haphazard fashion. In the UK, in an attempt to standardise quality of services, guidance for PICUs was published in 2002. Subsequently there has been a paucity of information outlining compliance with standards within different units.

Aims: To describe adherence to a subset of national standards in the care of 332 patients admitted consecutively to seven English PICUs.

Methods: Prospective, multi-centre patient case note analysis and staff questionnaire for each patient admitted.

Results: There was significant variation in different PICUs’ compliance with standards. Seventeen percent of patients were deemed not to meet basic criteria for admission to PICU. Pre-admission assessment and identification of treatment aims were poorly adhered to. Inappropriate mix of gender within patients occurred following 33% of admissions.

Conclusions: Implementation of national standards varies between different PICUs according to local policy and interface between acute wards and PICUs. This highlights the importance of, and challenge for, a national accreditation scheme.

Aims and Methods: A retrospective cohort was identified to examine the impact of information availability on outcome of emergency psychiatric assessment.

Results: Of 144 assessments undertaken during a 2-month period, 110 (76%) involved patients already known to regional psychiatric services, with records held on-site and remote from acute services at the District General Hospital site. 18 (16%) on-site clinical records were accessed during emergency assessments, only 3 (3%) of which were accessed during out-of-hours. No off-site records were accessed. Admission rates were low, with only 22 (15%) of assessments leading to admission and 63 (44%) resulting in onward referral to other services. Outcome for in- and out-of-hours assessments did not differ.

Conclusion: Our data failed to show a significant effect of accessing clinical records on admission rate.

Adverse cutaneous reactions are known to occur in approximately 5% of individuals prescribed antipsychotics. A case report of a 27 year old male who developed an allergic rash after six weeks of treatment with olanzapine, which reoccurred with more aggression following a single dose of risperidone, is described. To my knowledge, this is the first case to be reported in the literature.

Clozapine has been found to be of superior efficacy in treatment-resistant schizophrenia. However, haematological complications of clozapine are much better known than the equally serious cardiac complications. The potential risk of cardiovascular complications persists throughout the duration of clozapine use, as compared to a higher incidence of agranulocytosis being more pronounced during the first year of treatment. We describe a case of a young male with a diagnosis of treatment-resistant schizophrenia who developed clozapine related cardiomyopathy after being maintained on the medication for about eighteen months. The only initial cardiovascular findings were sinus tachycardia on both physical and electrocardiographic examinations. Subsequent echocardiography showed evidence of impaired ventricular systolic function. A repeat echocardiogram, three months post clozapine termination, showed improved ventricular functions. Sinus tachycardia also resolved both on physical and electrocardiographic examination. A high level of clinical suspicion and clozapine withdrawal after an early cardiology liaison proved beneficial in appropriately managing this case. The case report ends with suggestions of good practice points in managing clozapine related cardiomyopathy.

Evidence suggests violence and aggression are key reasons for admission to Psychiatric Intensive Care Units (PICUs). Research and national guidelines highlight the potential benefits of anger management interventions in this setting, however such interventions are often only offered in a minimal number of units. This paper describes the implementation of a two session cognitive behaviour therapy informed anger management intervention within a PICU setting. Twelve service users completed the sessions. There was a statistically significant reduction in the frequency of violent and aggressive incidents instigated by these patients in the two week period post intervention compared to the two weeks prior. It is possible that participation in anger management sessions contributed to the reduction in violence and aggression; however, large scale, longer term research is necessary controlling for other contributing variables, in order to establish the true effectiveness of this approach.

The Lifemusic project ran from 2008–2011 as part of a UK government funded programme demonstrating the potential benefits to community well-being from knowledge exchange between universities and their local communities. The Lifemusic method, which grew out of 20 years of development and community practice, uses music improvisation as a primary resource for group health and well-being. It presented a training programme and over 400 workshops with a variety of client groups including mental health. This paper introduces and outlines the Lifemusic method, placing it within a tradition of humanistic approaches to community health and goes on to describe its impact in a mental health facility where the approach was introduced and sustained. It looks at the practical aspects of setting up the programme, the challenges of client participation and sustainability and outlines the positive outcomes and benefits to patients and the methodology used in measuring well-being.

Suicide is a problem for society. On examination, current medical/legal concepts of suicide and responsibility rely on imprecise definitions and neglect aspects of suicide which are social rather than medical. A non-medical approach to those cases of people at risk who do not suffer a mental disorder is suggested, along with factors to be considered when the actions of mental health professionals are being evaluated.

Introduction: Quality of life is an important measure of results in psychiatry in general, and in the treatment of schizophrenia in particular. The metabolic syndrome has a strong prevalence in schizophrenia, and can have an impact on quality of life.

Objective: To compare the perceived quality of life of a sample of schizophrenic patients with and without metabolic syndrome.

Methods: Cross-sectional observational study, including 136 patients (49 with metabolic syndrome) admitted in 2004 to a short-term hospitalization psychiatric unit with a diagnosis of schizophrenia or schizoaffective disorder validated using the SCID-I. Metabolic syndrome defined according to NCEP-ATP III criteria. Quality of life assessed using the EuroQol 5D. Simple associative, and multivariate analysis (logistic regression) were performed.

Results: In the schizophrenic patients studied, metabolic syndrome is associated with age (p = 0.035), pension beneficiary (p = 0.005), antipsychotics treatment (p = 0.017), years of evolution (p = 0.008), and also with a lower score on the EuroQol 5D ‘health state today’ (p = 0.035) and ‘mobility’ (p = 0.011) dimensions. Multivariate analysis (logistic regression) shows that quality of life is mainly associated with age (OR = 3.2), metabolic syndrome (OR = 2.6) and mobility problems (OR = 2).

Conclusion: When treating schizophrenic patients, we should take into account comorbidity with metabolic syndrome, since the latter, in addition to representing a significant cardiovascular risk factor, can also affect, added to treatment issues, illness factors and other social and environmental variables, the patient’s quality of life.

We report on an adolescent with Asperger's syndrome who developed acute pancreatitis during treatment with risperidone and citalopram. On discontinuation of psychopharmacotherapy, he fully recovered. A rechallenge testing of citalopram did not result in a relapse of pancreatitis. Other known causes of pancreatitis were not obvious. Clinicians should be alert to this rare adverse event in patients who exhibit symptoms of an acute abdominal disorder during risperidone treatment.

Substance abuse is a frequent comorbidity in patients referred for severe acute psychiatric disorders, but is not always documented in medical record diagnoses. We estimated the presence of substance abuse problems in 74 acute patients in a psychiatric intensive care unit. Instruments used were the AUDIT (Alcohol Use Disorders Identification Test), and DUDIT (Drug Use Disorders Identification Test). Medical record diagnoses were divided into four groups: psychotic disorders (N=18), affective disorders (N=34), substance abuse disorders (N=9) and other diagnosis (N=13).

The AUDIT questionnaire indicated scores above cut-off for seven (38.9%) patients with a psychotic disorder, 18 (52.9%) with an affective disorder, six (66.7%) with a substance abuse diagnosis and three (23.1%) with other diagnoses. The DUDIT questionnaire indicated scores above cut-off for six (33.3%) patients with a psychotic disorder, four (11.8%) with an affective disorder, seven (77.8%) with a substance abuse diagnosis and none of the patients with other diagnoses. The sensitivity and specificity of the AUDIT test in this sample were calculated as 0.67 and 0.57 respectively and of the DUDIT test as 0.78 and 0.13 respectively.

Substance abuse in patients in an acute ward is under-communicated in medical record file diagnoses. Using tests could enhance diagnostic accuracy and help clinicians in choosing correct treatment.