A survey was conducted to investigate physical assaults against mental health staff of a Nigerian psychiatric hospital in a 12-month period and also during their working career in the hospital retrospectively using a questionnaire method.

In total, 101 out of 120 questionnaires were completed (response rate 84.2%). Within the period of their employment in the hospital 49.5% of staff had been physically assaulted at least once, and over the previous 12 months 33.7% had been physically assaulted. Nursing staff (82.3%) were more frequently assaulted than doctors, most often during routine assessment of patients (44.3%). In total, 88% of staff sustained injuries requiring medical attention. Vulnerability to assaults was not associated with attending a course on prevention and management of psychiatric patient violence.

Assaults by patients against mental health staff, especially nurses, are quite widespread in Nigeria. There is a need to formulate policies on prevention and management of violence in people with mental disorders in Nigerian psychiatric hospitals.

A retrospective case-note review was undertaken at five English prisons between June 2008 and March 2009 to estimate the proportion of psychiatric medicines (antidepressants, antipsychotics and hypnotics/anxiolytics) reported at prison reception that are discontinued on entry to prison.

Of the 1006 records sampled, the review showed that 18% of prisoners had been prescribed psychiatric medication before being placed in custody. Altogether, 240 separate psychiatric medicines were recorded among prisoners at reception. Of these, 47% were not prescribed during the first week of custody. In only 11% of cases where medication was discontinued had psychiatric assessment been completed.

Prison mental health policy states that psychiatric medication should not be withdrawn in custody without proper clinical assessment. Denial of medication in the absence of clinical assessment during early custody has the potential to create additional stress in individuals during a period of increased vulnerability and risk.

We investigated deliberate and inadvertent off-label prescribing in individuals with recurrent depressive disorder attending a community mental health service.

Off-label prescribing occurred in 87 of 226 people with recurrent depressive disorder (38%) and involved antipsychotic agents (41), maintenance benzodiazepine use (33), antidepressant polypharmacy (28), high-dose antidepressants (19) and use of antidepressants outside of the recommended age range (16). Off-label prescribing was part of a deliberate and documented treatment plan for a half (n = 43) of individuals. Participants receiving off-label prescribing had higher total Health of the Nation Outcome Scale (HoNOS) scores, were attending more frequently and were older and had more chronic illness duration. Inadvertent off-label prescribing was related to higher scores on the behavioural disturbance subscale of the HoNOS.

Off-label prescribing is a common phenomenon in people with recurrent depressive disorder and relates to greater illness severity and chronicity. Although off-label prescribing is frequently deliberate, in many cases it is undesirable and unplanned.

Tackling discrimination, stigma and inequalities in mental health is a major UK government objective yet people with intellectual disability (also known as learning disability in UK health services) continue to suffer serious stigma and discrimination. We examine the effect of viewing pictures of a person with intellectual disability on stigmatised attitudes. The 20-point Attitude to Mental Illness Questionnaire (AMIQ) was used to assess stigmatised attitudes. Members of the general public were randomised to complete the questionnaire having looked at a good (attractive) or bad (unattractive) photograph of a person with intellectual disability.

Questionnaires were received from 187 participants (response rate 74%). The mean AMIQ stigma score for the bad photo group was 1.3 (s.e. = 0.3, median 1, interquartile range (IQR) = 0–3, n = 82). The mean AMIQ score for the good photo group was 2.8 (s.e. = 0.3, median 3, IQR = 1–5, n = 105). The difference in AMIQ stigma score was highly significant (two-sided P = 0.0001, median difference 2, Mann–Whitney U-test).

Looking at a good (attractive) picture of a person with intellectual disability significantly reduces reported stigmatised attitudes, whereas a bad (unattractive) picture has no effect.

The effectiveness of official support provided following a disaster has not been fully evaluated. This study aimed to ascertain whether there was an association between perceived support shortly after the 2004 Indian Ocean tsunami and later mental health symptoms in those affected, and to explore the factors associated with this. A survey, semi-structured interviews and focus group were used to explore the experiences and perceptions of 116 individuals severely affected by the tsunami.

Agency or official support was perceived as poor overall. Perceived ineffectiveness of support available within a few days after the tsunami was associated with increased symptoms of post-traumatic stress disorder 15–19 months later. The strongest themes that emerged from our study were that support provided in a humane manner was perceived as effective and that uncoordinated support, poor communication and limited accessibility to support and information were perceived as ineffective.

Improved planning of coordinated, flexible, multi-agency responses to traumatic events before they occur is required.

We surveyed 180 experienced psychiatrists on their training and practice in diagnosing and managing tardive dyskinesia in the current atypical antipsychotic era.

About two-thirds of psychiatrists (n = 124, 69%) responded to the survey. A significant minority had no training in tardive dyskinesia, yet almost everyone recognised the need for formal training in this area. We noted a discrepancy between what respondents believed should be their ideal practice and their reported actual clinical practice. As many as 58% considered that tardive dyskinesia could be a reason for patients to pursue litigation. Many had concerns about prescribing antipsychotics for unlicensed indications, especially for incapacitous patients.

It is important to recognise current practice and gaps in training, not only to enhance training and patient care but also to mitigate against the risk of litigation.

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.

To assess the extent to which psychiatric history, with specific regard to compulsory psychiatric admission, is questioned in visa, insurance and permit applications. Application forms for the top UK destinations for immigration, work and travel visas, six types of insurance, and driving, sporting and vocational permits were analysed.

Psychiatric history is questioned in some applications across all visa types. Hospital admission, but not compulsory psychiatric admission, is questioned in some immigration visas. Psychiatric history is not questioned in mortgage protection, car or pet insurance but it is questioned in some travel, life and health insurance applications, as is hospital admission. The majority of permit applications questioned psychiatric history and one vocational permit considered compulsory psychiatric admission.

The majority of visa, insurance and permit application forms enquire about past medical and psychiatric history. Information concerning detention under the Mental Health Act is very rarely questioned, indicating that a direct link between detention and access restriction is not evident.