To examine the effectiveness of integrating evidence-based supported employment into an early intervention service for young people with first-episode psychosis. Demographic, clinical and vocational data were collected over a 12-month period to evaluate the effect on vocational outcomes at 6 months and 12 months of the employment of a vocational specialist, and to assess model fidelity.

Following vocational profiling and input from the vocational specialist and the team, there were significant increases in the proportion of clients engaged in work or educational activity over the first 6 months of the intervention, and in a subsample over a second 6-month period. The evidence-based Supported Employment Fidelity Scale was used to measure the degree of implementation, which scored 71, signifying ‘good implementation’.

The results suggest that implementing evidence-based supported employment within an early intervention service increases employment and education opportunities for patients within the service.

The aim of the study was to investigate the use of clozapine in treatment-resistant schizophrenia and its impact on hospitalisation rates when prescribed in accordance with National Institute for Clinical Excellence (NICE) guidelines. Case records were examined of patients admitted to the psychiatric unit of Glan Clwyd Hospital between 1996 and 2001.

Of 59 patients identified as having treatment-resistant schizophrenia, 83% had been considered for clozapine, 48% were taking clozapine, 20% had refused the drug and 15% had stopped taking it because of side-effects. The mean annual hospitalisation rate for patients receiving clozapine for a minimum of 3 years was 13.5 days, markedly lower than those not receiving this drug (34.0 days, P=0.03). Older patients were less likely to have been offered clozapine (P=0.006).

This study supports the NICE guidelines recommending clozapine for patients with treatment-resistant disease. Clozapine is offered less often to older patients; factors influencing this require investigation.

People receiving electroconvulsive therapy (ECT) in one clinic completed side-effect rating questionnaires during treatment, and a questionnaire rating their experience of different aspects of treatment on completion of the treatment course.

Side-effects were commonly reported, but predominantly rated as mild or moderate. Most people reported that ECT had made them a little or a lot better, and that the treatment had been fairly or very well explained. Fewer than a fifth of respondents rated ECT as slightly or much worse than going to the dentist.

We recommend routine monitoring of the subjective experience of ECT, during treatment and on completion of the course. Ratings should inform the treatment plan, the policies and procedures of the ECT clinic.

This study aimed to investigate the potential benefits of a low glycaemic index diet in patients with schizophrenia taking clozapine. Seven patients consented to participate in a 5-week pilot study. Measurements were taken of body weight, random blood glucose and cholesterol levels.

The mean weight loss per patient was 2.9 kg in 4 weeks. Random blood glucose levels reduced from a mean of 5.3 mmol/l at the beginning of the study to 4.7 mmol/l at the end.

A low glycaemic index diet may possibly reduce the substantial cardiovascular risk in patients receiving antipsychotic medication.

There are few descriptions in the literature of pharmacogenetic applications in psychiatry. We describe the relevance of pharmacogenetics to clinical psychiatry using a case-note review of the first 55 patients to have their cytochrome P450 (CYP2D6) status assessed in a general psychiatry clinic.

The distribution of genotypes for CYP2D6 was the same as in the general population. A smaller number of reported side-effects (P=0.01) and higher medication dosages (P=0.001) were significantly associated with the extensive metabolism genotype.

This preliminary study suggests that CYP2D6 status may have an influence on medication dosage and adverse drug events reported by patients. Recommendations for further development are suggested.