Mephedrone is a cathinone with amphetamine-like stimulant effects, and is a commonly used recreational drug. The adverse effects of mephedrone use have not been extensively studied. All individuals who self-presented between January and June 2010 to the emergency departments and acute mental health services in Edinburgh and Falkirk with adverse effects of self-reported mephedrone use were identified.

Twenty cases were identified and analysed. Severe agitation was the most common presenting problem (70%), with 40% of individuals developing psychotic symptoms and a further 20% reporting low mood and suicidality. One person died by suicide.

Mephedrone can produce amphetamine-like adverse psychological intoxication effects, particularly in those with a history of mental illness. Clinicians should consider advising patients on the adverse effects of mephedrone, where relevant.

Our aim was to follow-up on a cohort of self-referred doctors who attended MedNet. We used a two-point cross-sectional design. Measures included three standardised self-report questionnaires administered before and after consultation. Doctors were also asked to complete a service user questionnaire, and data regarding engagement and onward referrals were gathered through case-note review.

A statistically significant improvement in scores on all three questionnaires was found after intervention; however, scores on one subscale, the risk domain of the Clinical Outcomes in Routine Evaluation – Outcome Measure, did not change significantly. Of the doctors at no risk of suicide at intake, nearly two-thirds (n = 41/70, 59%) were sufficiently helped by the consultations provided to not need further treatment. Of the doctors at some risk of suicide at intake, two-thirds (n = 34/51, 67%) did need an onward referral. Only one doctor required hospital admission, an outcome that suggests the approach used is containing and clinically responsive.

This paper highlights the efficacy, need and importance of specialist services for doctors in difficulty. We found that the bespoke consultation model provided at MedNet is valued highly by the doctors as service users.

To assess attitudes of general practitioners (GPs) on who should be responsible for managing metabolic dysregulations associated with the use of antipsychotics prescribed by psychiatrists. A total of 121 GPs in West Galway catchment area were surveyed using a simple questionnaire.

A total of 104 GPs responded (86% response rate). The vast majority of responders (82%) believed that medical management should be provided within primary care. However, 46% indicated that initial screening and simple non-pharmacological management should be provided by mental health services.

The vast majority of GPs appear willing to take over the medical management of metabolic dysregulations emerging from antipsychotic prescribing in secondary care. Clearly defined roles for mental health services and primary care in the management of metabolic complications are of paramount importance, and individual mental health services should implement protocols for screening, non-pharmacological management and referral to primary care.

To report the rates of violent and aggressive incidents at a drug treatment clinic using a newly introduced incident reporting tool (STARSWeb) and to describe the management strategies currently employed in the management of incidents at the centre. This involved the review of all completed incident reports for the year 2008 and the examination of relevant patient factors.

There were 276 documented incidents at the centre in 2008. The majority of incidents (72.4%) involved verbal abuse and threatening behaviours. Males were responsible for the majority of incidents. Two-thirds of the clients' urine samples were positive for illicit substances at the time of the incidents.

Violent and aggressive incidents in healthcare settings continue to pose a real challenge to both service providers and service users. An accurate system of reporting of such incidents is indispensable in guiding policy development and management strategies. The STARSWeb system offers a significant improvement in incident reporting towards the attainment of these goals.

We hypothesised that, because of stigma associated with mental illness, patients' knowledge of psychotropic medication would be less than that of non-psychotropic medication. We set out to establish the extent of knowledge about these medications using a cross-sectional survey of in-patients over 65 years of age in south London.

Of the study population (n = 86), 42% demonstrated an understanding of the purpose of taking both psychotropic and non-psychotropic medication, 15% understood only their psychotropic medication, 16% understood only their non-psychotropic medication and 27% understood neither medication. A surprising finding was that more than 20% of these patients with cognitive impairment were not able to recount their legal status; this factor was independently related to whether or not they knew the purpose of their psychotropic medication, and also whether or not they knew the purpose of neither type of medication.

Poor knowledge of medication has been associated with non-adherence and relapse. Older adults are likely to receive multiple medications because of their increased susceptibility to physical and psychiatric disorders with increasing age, so even more emphasis has to be placed on increasing knowledge of medication.

To assess the stability of the diagnosis of first-episode drug-induced psychosis over a follow-up period of at least 2 years. Patients with no psychiatric history who had been discharged from in-patient care between January 2002 and April 2006 with a firm diagnosis of drug-induced psychosis were identified. Follow-up information for at least the next 2 years or until discharge from mental health services was collected retrospectively from psychiatric records.

Nearly all of the patients who remained under psychiatric follow-up had a change in diagnosis, most commonly to a schizophreniform disorder. Those who were retained in follow-up had significantly longer index admissions than those discharged to primary care (P = 0.05).

This study suggests that many individuals diagnosed with drug-induced psychosis are further diagnosed as having a functional psychosis, usually schizophreniform in nature. This is compatible with the suggestion that individuals diagnosed with drug-induced psychosis are experiencing either the effects of drug intoxication or an ordinary functional psychosis complicated by incidental drug use.

Revalidation is the process by which doctors demonstrate that they are up to date and fit to practise. Case-based discussion has been identified by both psychiatrists and service users and carers as a potentially useful tool for revalidation. The aim of this study was to examine the feasibility of case-based discussion for assessments to use in revalidation. A pilot using case-based discussion as an assessment/developmental technique for revalidation was undertaken in six trusts involving 86 consultant psychiatrists.

The average time taken for each case-based discussion including preparation and reflection was 48 min. All but one of the doctors involved in the case-based discussion pilot described the process as useful or very useful in improving clinical practice. In total 87% of the assessed doctors and all of the assessors reported that they considered case-based discussion to be a useful part of the revalidation process assessed. The majority of doctors assessed believed that cases should be chosen at random (91%).

Case-based discussions have the potential to be a useful quality improvement tool for revalidation.