To evaluate the practical utility and face validity of a new risk assessment guideline, the Short-Term Assessment of Risk and Treatability (START), within a forensic mental health service. Staff attended training and subsequently used the START to assess and formulate risk. Staff then completed an evaluation questionnaire about their experiences of using the START.

RESULTS

The study proved useful in evaluating the practical utility and face validity of the START. The START demonstrated both good practical utility and face validity. Areas of difficulty in completing the START were identified and areas for developing the START were highlighted.

CLINICAL IMPLICATIONS

The service subsequently implemented a revised version of the START into routine practice. The results of the pilot study suggest that the START can usefully assist in structuring risk judgements in practice.

The internet is an important source of mental health information. Given variable literacy levels in the general public, patient information websites need to be easily readable to prevent misunderstanding and consequent misinformation about mental health problems being propagated. The aim was to ascertain the readability of websites containing patient information about schizophrenia. Twenty websites containing patient information about schizophrenia generated by Google^TM were analysed for Flesch Reading Ease and Flesch-Kincaid Grade Level.

RESULTS

According to standardised Flesch Reading Ease classification, 40% of the selected sites were classified as very difficult, 55% as difficult and 5% as fairly difficult. None were considered easy to read. There was a negative correlation of –0.798 (P<0.001) between Flesch Reading Ease and Flesch-Kincaid Grade Level, which demonstrates the reliability of these results.

CLINICAL IMPLICATIONS

Easily accessed schizophrenia information websites do not score highly for readability. Those that produce websites should bear readability in mind when writing them in order to construct more readable sites. Ideally, these should be accredited by recognised organisations that evaluate readability. Clinicians should assess website information for readability before recommending them to patients or carers.

To investigate the effects of a standard National Health Service early intervention in psychosis service on bed days and engagement with services. We conducted a naturalistic before-and-after study comparing outcomes of individuals who received treatment from the service (n=75) with outcomes of individuals who presented to mental health services before the early intervention service was established and received treatment as usual (n=114).

RESULTS

People treated by the early intervention in psychosis service had significantly fewer admissions (P<0.001), readmissions (P<0.001), total bed days (P<0.01) and better engagement with services (P<0.05).

CLINICAL IMPLICATIONS

An early intervention in psychosis service compliant with current British mental health policy led to reduced use of psychiatric bed days confirming recent findings elsewhere. This leads to major financial savings, easily justifying the initial cost of investment in the service.

A cross-sectional survey of patient drug prescriptions on two elderly psychiatric wards was carried out to estimate the potential of drug-drug interactions. Two standardised databases, British National Formulary (BNF; British Medical Association & Royal Pharmaceutical Society of Great Britain, 2007) and Upto Date (www.uptodate.com/), were employed.

RESULTS

A majority (96%) of drug prescriptions in our study could potentially cause drug-drug interactions. Most patients were on multiple drugs (on average eight drugs per patient). There was poor concordance between the two databases: BNF picked up fewer cases of potential drug-drug interactions than Upto Date (43 v.152 instances) and they also estimated the potential for hazardousness differently.

CLINICAL IMPLICATIONS

Polypharmacy is common in elderly psychiatric patients and this increases the possibility of a drug-drug interaction. Estimating the risk of interactions depends on a sound knowledge in therapeutics and/or referring to a standardised source of information. The results of this study question the concordance of two well-referenced databases.

Health promotion campaigns using current terminology have had limited success in reducing stigma to schizophrenia. Terminology and subgroups based on historical precedent, clinical experience and psychosocial research have been developed to provide an alternative to existing terminology, and the attitudes to schizophrenia and alternative terminology of a sample of medical students (n=241) were compared.

RESULTS

Overall attitudes were significantly less negative with the alternatives. The students were less negative about the potential for recovery in relation to all the subgroups than for schizophrenia. Concerns about dangerousness were also less prominent with the exception of the drug-related group.

CLINICAL IMPLICATIONS

Subgroups and alternative terminology should be further explored in programmes to destigmatise schizophrenia.

Adolescents presenting with self-harm have poor adherence to community follow-up. Poor adherence is a principal obstacle to treatment delivery and is associated with poor psychosocial outcomes. Therapeutic assessment is a novel method of assessing adolescents with self-harm. We compared therapeutic assessment with assessment as usual in a pilot study of 38 adolescents referred for psychosocial assessment following self-harm.

RESULTS

Significantly more adolescents assessed with therapeutic assessment than with usual assessment attended the first community follow-up appointment (75% v. 40%, ²=3.89, P<0.05) and engaged with services (62% v.30% ²=4.49, P<0.05).

CLINICAL IMPLICATIONS

Young people assessed using therapeutic assessment may be more likely to engage with community follow-up. A therapeutic intervention at the time of the initial assessment might be necessary to enable future therapeutic work.

To examine service-level variables predicting treatment adherence in a specialist eating disorder unit. We analysed a sample of 157 individuals consecutively referred to the unit over an 18-month period. Associations were determined using odds ratios.

RESULTS

Individuals with a formal care programme at the point of referral were more likely to stay in treatment. Treatment adherence was not predicted by illness severity or waiting time. Follow-up by a dietician and acceptance of referral to a support group predicted better treatment outcomes.

CLINICAL IMPLICATIONS

Although the standard care programme approach may be relinquished in the UK, we recommend that this approach or its equivalent be used in specialist eating disorder services to improve treatment adherence.