The effectiveness of joint crisis plans for people with borderline personality disorder: protocol for an exploratory randomised controlled trial.

Background: Borderline personality disorder (BPD) is a common mental disorder associated with raised mortality, morbidity and substantial economic costs. Although complex psychological interventions have been shown to be useful in the treatment of BPD, such treatments are expensive to deliver and therefore have limited availability and questionable cost-effectiveness. Less complex interventions are required for the management of BPD.

Packages of care for schizophrenia in low- and middle-income countries.

In the third in a series of six articles on packages of care for mental disorders in low- and middle-income countries, Jair Mari and colleagues discuss the treatment of schizophrenia.

Packages of care for mental, neurological, and substance use disorders in low- and middle-income countries: PLoS Medicine Series.

In a Perspective article, Vikram Patel and Graham Thornicroft introduce a new series in on mental health disorders in low- and middle-income countries that reviews the evidence for packages of care for ADHD, alcohol misuse disorders, dementia, depression, epilepsy, and schizophrenia.

Implementation science: understanding the translation of evidence into practice.

This editorial summarises what is known about accelerating the transfer of discoveries in the health sciences into implementation in routine clinical practice. Three phases are described: adoption in principle, early implementation, and persistence of implementation. Facilitators and barriers to the implementation across these phases are discussed.

An empirical method to identify patterns in the course of psychotic episodes of people with schizophrenia.

Objective: This paper illustrates the process of constructing, selecting and applying simple measures in order to empirically derive patterns of course of psychotic episodes in schizophrenia.

Method: Data were collected with a composite instrument constructed for a multi-centre, follow-up randomized controlled trial of adherence therapy for people with schizophrenia. The instrument included a retrospective weekly assessment of psychotic/non-psychotic status, which was used to derive the measures, and the DSM-IV course specifiers.

The South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) case register: development and descriptive data.

Background: Case registers have been used extensively in mental health research. Recent developments in electronic medical records, and in computer software to search and analyse these in anonymised format, have the potential to revolutionise this research tool.

Methods: We describe the development of the South London and Maudsley NHS Foundation Trust (SLAM) Biomedical Research Centre (BRC) Case Register Interactive Search tool (CRIS) which allows research-accessible datasets to be derived from SLAM, the largest provider of secondary mental healthcare in Europe.

Comparison of patient and clinician perspectives in the assessment of antipsychotic medication adherence.

Background: Factors influencing patient and clinician perspectives in the assessment of medication adherence have never been compared.

Method: This study used baseline and 12-month follow-up data from the QUATRO study, an international multicentre study. At baseline, information on patient sociodemographic characteristics, treatment factors, psychopathology, functioning and experience of antipsychotic side effects was gathered.

Caring for people with depression or with schizophrenia: are the consequences different?

Attention to caregiver consequences has been mainly restricted to caregivers of patients with schizophrenia. The few studies done in depression were conducted on small samples and/or with non-validated instruments. Caregiver consequences in depression and schizophrenia were measured with the validated Involvement Evaluation Questionnaire (IEQ).

Implications of long-term conditions for both mental and physical health: comparison of rheumatoid arthritis and schizophrenia.

Purpose: To investigate whether people with long term conditions, whatever their specific nature, need to be assessed and treated for the full range of mental, physical and social problems. Main question investigated: that rheumatoid arthritis and schizophrenia will be associated with significantly greater impairment across the subscores of the SF36 scale than in reference general population samples. Specific hypothesis tested: while rheumatoid arthritis and schizophrenia will impair both physical and mental functioning, when comparing the two groups there will be a greater difference between the physical component scores than there will be between the mental/emotional component scores of the short form health survey (SF-36).

In-patient and residential alternatives to standard acute psychiatric wards in England.

Background: Acute psychiatric wards have been the focus of widespread dissatisfaction. Residential alternatives have attracted much interest, but little research, over the past 50 years.

Aims: Our aims were to identify all in-patient and residential alternatives to standard acute psychiatric wards in England, to develop a typology of such services and to describe their distribution and clinical populations.

A comparison of SF-6D and EQ-5D utility scores in a study of patients with schizophrenia.

Background: Economic evaluations of healthcare interventions increasingly measure outcomes using quality-adjusted life years (QALYs). The SF-6D and the EQ-5D are alternative ways of generating utility scores for use in QALY estimations, but it is unclear which is most sensitive to change in psychiatric symptom severity. There are also limited data on the sensitivity of these measures to changes in existing clinical indicators in long-term mental health conditions like schizophrenia.

Public attitudes towards people with mental illness in England and Scotland, 1994-2003.

Background: Understanding trends in public attitudes towards people with mental illness informs the assessment of ongoing severity of stigma and evaluation of anti-stigma campaigns.

Aims: To analyse trends in public attitudes towards people with mental illness in England and Scotland using Department of Health Attitudes to Mental Illness Surveys, 1994-2003.

Method: We analysed trends in attitudes for 2000 respondents in each survey year (6000 respondents in 1996 and 1997) using quota sampling methods and the adapted Community Attitudes Toward the Mentally Ill scale.

Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey.

Background: Many people with schizophrenia experience stigma caused by other people's knowledge, attitudes, and behaviour; this can lead to impoverishment, social marginalisation, and low quality of life. We aimed to describe the nature, direction, and severity of anticipated and experienced discrimination reported by people with schizophrenia.

Methods: We did a cross-sectional survey in 27 countries, in centres affiliated to the INDIGO Research Network, by use of face-to-face interviews with 732 participants with schizophrenia.

Course of adherence to medication and quality of life in people with schizophrenia.

This study examined the relationship over time of adherence to anti-psychotic medication and quality of life in people with schizophrenia, taking into account effects of mediating variables. Data on on adherence, quality of life, attitude towards medication, side effects, symptom severity, and level of functioning at baseline and 1-year follow-up were obtained from 373 participants in a multi-centre trial. Participants randomised to the intervention group were offered eight sessions of adherence therapy.

The Camberwell elderly mentally ill and their needs for services.

Background: Previous studies on the elderly mentally ill (graduates) have been undertaken in mental hospital settings and on populations being resettled from hospitals. This paper aims to assess the characteristics and service needs of an epidemiological sample of elderly mentally ill.

Aims: The aim of this study was to identify the characteristics, problems, service utilization and needs of a sample of elderly patients with functional psychosis in a defined epidemiological area.

Views of service users and providers on joint crisis plans: single blind randomized controlled trial.

Introduction: We report participants' and case managers' use of and views on the value of Joint Crisis Plans (JCPs), shown to reduce compulsory hospitalisation and violence.

Method: One hundred sixty people with psychosis or bipolar disorder participated in a randomized controlled trial. Intervention group participants were interviewed on receipt of the JCP, on hospitalisation, and at 15 month follow-ups; case managers were interviewed at 15 months.

Why is recruitment to trials difficult? An investigation into recruitment difficulties in an RCT of supported employment in patients with severe mental illness.

Background: Under-recruitment to randomised controlled trials (RCTs) is often problematic and there may be particular difficulties in recruiting patients with severe mental illness.

Aim: To evaluate reasons for under-recruitment in an RCT of patients with severe mental illness

Methods: Qualitative study during the recruitment phase of an RCT of supported employment. Trial staff and recruiting clinicians were interviewed.

Is the Defined Daily Dose system a reliable tool for standardizing antipsychotic dosages?

The present study was carried out to establish whether the Defined Daily Doses (DDDs) system could be reliably applied to standardize antipsychotic dosages. Initially, the relationship between antipsychotic doses expressed as DDDs, chlorpromazine equivalents (CPZEs) and percentages of the British National Formulary (BNF) maximum recommended daily dose were investigated by calculating Spearman's rank correlation coefficients. Second, factors associated with antipsychotic dose, expressed as DDDs, CPZEs and percentages of the BNF maximum recommended daily dose, were investigated by means of linear regression analysis.

Clinical pathways in psychiatry.

This editorial summarises the literature on the use of care pathways in psychiatry. Further, it considers the case-mix clusters used in care pathways in relation to health service financial tariff and currency systems, and also reviews the evidence for the effectiveness of clinical pathways.

Steps, challenges and lessons in developing community mental health care.

This paper summarises our own accumulated experience from developing community-orientated mental health services in England and Italy over the last 20-30 years. From this we have provisionally concluded that the following issues are central to the development of balanced mental health services: a) services need to reflect the priorities of service users and carers; b) evidence supports the need for both hospital and community services; c) services need to be provided close to home; d) some services need to be mobile rather than static; e) interventions need to address both symptoms and disabilities; and f) treatment has to be specific to individual needs. In this paper we consider ten key challenges that often face those trying to develop community-based mental health services: a) dealing with anxiety and uncertainty; b) compensating for a possible lack of structure in community services; c) learning how to initiate new developments; d) managing opposition to change within the mental health system; e) responding to opposition from neighbours; f) negotiating financial obstacles; g) avoiding system rigidities; h) bridging boundaries and barriers; i) maintaining staff morale; and j) creating locally relevant ser- vices rather than seeking "the right answer" from elsewhere.

Stigma and discrimination limit access to mental health care.

This editorial provides an overview of how far access to mental health care is limited by perceptions of stigma and anticipated discrimination. Globally over 70% of young people and adults with mental illness receive no treatment from healthcare staff. The rates of non-treatment are far higher in low income countries.

Reducing stigma and discrimination: Candidate interventions.

This paper proposes that stigma in relation to people with mental illness can be understood as a combination of problems of knowledge (ignorance), attitudes (prejudice) and behaviour (discrimination). From a literature review, a series of candidate interventions are identified which may be effective in reducing stigmatisation and discrimination at the following levels: individuals with mental illness and their family members; the workplace; and local, national and international. The strongest evidence for effective interventions at present is for (i) direct social contact with people with mental illness at the individual level, and (ii) social marketing at the population level.