Bipolar affective disorders contribute significant mortality and morbidity in the management of mental disorders in developed and developing countries. A recent review reported 12- month estimates of approximately 1% (range 0.5% - 1.1%). The current practice reveals large variations in the standards of care delivery with non existent protocols in third world countries. National Institute of Health and Clinical Excellence (NICE, United Kingdom) has developed guidelines that dictate the best practice in the management of Bipolar disorder in England and Wales.

We compared local adherence to and uptake of NICE guidelines for Bipolar affective disorders (supposedly the best practice).

To feedback Managers and practicing psychiatrists in the local trust about the shortcomings in the best practice as per national guidelines.

We reviewed the clinical notes of nearly one-third of all the service users diagnosed with Bipolar Affective Disorder (ICD code F31) in a rural county in England.

The need to discuss pharmacological options with the patients to help make them an informed choice as well as offering psychological treatments and life style advice were the most deficient areas of practice. We plan to reaudit the practice to document changes in practice.

To present a case of Huntington's Disease and discuss neuropsychiatric management.

Case presentation.

We would like to present a case of Huntington's disease in an adult asian-indian male. The poster consists of a case report followed by a discussion on Huntingtons. We discuss the aetiopathogenesis, presentation and recent management trends of this neuropsychiatric condition.

Mr. H was an Asian Indian immigrant in the United Kingdom. He presented with gradually worsening chorea, personality change and cognitive decline. Psychiatric symptoms closely followed with the development of aggression, paranoid delusions and visual and auditory hallucinations.

Management included a multidisciplinary approach involving psychiatrists, neurologists, the local Huntington's disease service and a host of Para clinical teams.

In the discussion, we trace the aetiology of Huntington's disease, the epidemiology and regional variations in Incidence and prevalence rates. The presentation, disease process and prognosis of Huntington's Disease is discussed. We present recent trends in management including the use of Omega 3 Fatty Acids.

Though there has been a significant increase in the amount of research on the condition, this appears to have been concentrated mainly on those populations with a higher prevalence. Studies on the causes of lower prevalence in Asian, especially Indian populations are still few in number. Such research could provide valuable clues including detection of protective factors in these populations. These in turn could prove useful in the management of the disease on both an individual and wider socio-economic level.

We present a case report highlighting the central role of psychiatrist in care coordination in spite of current trends when care is fragmented and provided by specialist teams. The importance of organic causation in bio-psycho-social case formulation and its treatment is emphasized.

To demonstrate the range of skills employed by practicing psychiatrist in optimising the care of the patients.

The role of Psychiatrists in managing risk in the suicidal patient with depressive illness is paramount and central.

The highlights in a patient’s journey are revisited via a review of medical notes.

The opinions of allied professionals and the split in the team in addressing heightened suicide risk is highlighted. The emphasis is placed on reflecting on when to end active management and consider a maintenance postion for the patient.

The concept of continuity of care and specialist knowledge of person in enhancing quality of care and optimising the patient outcome is firmly established.

In the United Kingdom, a Mental Health Tribunal has legal powers to discharge or uphold detention of patients who have been detained under the Mental Health Act. Detained patients cost a great deal of money for hospitals and tribunal services.

The purpose of the study was to identify whether patients were detained as per mental health legal criteria or not. We also considered the economic impact of these tribunals.

We collected and analyzed data from 300 tribunals held between 2006 and 2011.The most commonly used sections were - Sections 2, 3, 37 and 37/41.

Our analysis showed that:

1. - Majority of patients detained under Section 2 were not discharged.

2. - Very few patients detained under Section 37/41 were discharged.

Blumenthal and Wessley (1994) reported that the total cost of holding Mental Health Review Tribunals was £12,274,380. In Scotland, the total costs for all Tribunal related activity in 2006–07 was £12,784,909.

In the current economic scenario it is worth investigating cost effective alternatives to Tribunals - especially in cases of Section 2 and Section 37/41 - where the data indicates that tribunals do not change the original recommendation.

Viable alternative would include locally conducted Managers Hearings; However it is of paramount importance to ensure patients’ rights and the presence of independent panel members in such hearings.

We propose that more analysis, on a national level would be needed to determine the current cost of Mental Health Tribunals and to consider cost effective alternatives.