Service utilisation and clinical outcomes of a newly developed specialist primary–secondary care liaison clinic for patients with medically unexplained symptoms (MUS) were evaluated in a cross-sectional and feasibility pilot study. The impact of body-oriented psychological therapy (BOPT) was explored in a small cohort of patients with an identified somatoform disorder.

Of 147 consecutive referrals, 113 patients engaged with the assessment process. Of patients with MUS, 42% (n= 45) had a primary diagnosis of somatoform disorder, 36% (n= 38) depressive disorder, and depressive symptoms (even subsyndromal) mediated the effect of somatic symptoms. A marked variation of presenting complaints and service utilisation across ethnic groups was noted. A significant reduction in somatic symptom levels and service utilisation was achieved for patients undergoing BOPT.

A high proportion of patients with MUS have undiagnosed and therefore untreated mental disorders. New and locally derived collaborative care models of active engagement in primary care settings are required. Patients with somatoform disorder may benefit from BOPT; this requires further evaluation in adequately powered clinical trials.

To assess the feasibility of conducting a larger, definitive randomised controlled trial of manual-assisted cognitive therapy (MACT), a brief focused therapy to address self-harm and promote engagement in services. We established recruitment, randomisation and assessment of outcome within a sample of these complex patients admitted to a general hospital following self-harm. We assessed symptoms of depressed mood, anxiety and suicidality at baseline and at 3 months' follow-up.

Twenty patients were randomised to the trial following an index episode of self-harm, and those allocated to MACT demonstrated improvement in anxiety, depression and suicidal ideation.

It is feasible to recruit a sample of these complex patients to a randomised controlled trial of MACT following an index episode of self-harm. There is preliminary support that MACT could be an acceptable and effective intervention in patients with personality disorder and substance misuse.

To determine values for reliable change and clinically significant change for the Leeds Dependence Questionnaire (LDQ) and Social Satisfaction Questionnaire (SSQ). The performance of these two measures with the Clinical Outcomes in Routine Evaluation (CORE-10) as three dimension measures of addiction was then explored.

The reliable change statistic for both LDQ and SSQ was ≥4; the cut-offs for clinically significant change were LDQ 410 males, ≤5 females, and SSQ ≥16. There was no overlap of 95% CIs for means by gender between ‘well-functioning’ and pre- and post-treatment populations.

These data enable the measurement of clinically significant change using the LDQ and SSQ and add to the evidence for the performance of the LDQ, CORE-10 and SSQ as dimension measures of addiction. The CORE-10 and SSQ can be used as treatment outcome measures for mental health problems other than addiction.

To explore experiences of psychiatrists considering medication for patients with personality disorder by analysis of transcribed, semi-structured interviews with consultants.

Themes show important relational processes in which not prescribing is expected to be experienced as uncaring rejection, and psychiatrists felt helpless and inadequate as doctors when unable to relieve symptoms by prescribing. Discontinuity in doctor–patient relationships compounds these problems.

Problems arise from: (a) the psychopathology creating powerful relational effects in consultation; (b) the lack of effective treatments, both actual and secondary to under-resourcing and neglect of non-pharmaceutical interventions; and (c) the professionally constructed role of psychiatrists prioritising healing and cure through provision of technological interventions for specific diagnoses. There is a need for more treatments and services for patients with personality disorder; more support and training for psychiatrists in the relational complexities of prescribing; and a rethink of the trend for psychiatrists to be seen primarily as prescribers.

To determine rates of parent-reported child awareness of parental depression, examine characteristics of parents, children and families according to child awareness, and explore whether child awareness is associated with child psychopathology. Data were available from 271 families participating in the Early Prediction of Adolescent Depression (EPAD) study, a longitudinal study of offspring of parents with recurrent depression.

Seventy-three per cent of participating children were perceived as being aware of their parent's depression. Older children, and children of parents who experienced more severe depression, were more likely to be aware. Awareness was not associated with child psychopathology.

Considering children in the context of parental depression is important. Child awareness may influence their access to early intervention and prevention programmes. Further research is needed to understand the impact of awareness on the child.

To develop a programme to help undergraduate medical students and postgraduate trainees to improve their skills in communicating with people with intellectual disabilities through teaching sessions that had input from simulated patients with intellectual disabilities. We conducted four sessions of training for 47 undergraduate 4th-year medical students. The training involved a multiprofessional taught session followed by a clinical scenario role-play with simulated patients who were people with intellectual disabilities. The training was assessed by completing the healthcare provider questionnaire before and after the training.

There were improvements in the students' perceived skill, comfort and the type of clinical approach across all three scenarios.

By involving people with intellectual disabilities in training medical students there has been a significant improvement in students' communication skills in areas of perceived skills, comfort and type of clinical approach which will raise the quality of care provided by them in the future.