Mental health nurse prescribing seems potentially beneficial. However, more rigorous audit and evaluation are needed to confirm its safety, patient satisfaction and health outcomes. Mental health nurse prescribing will require service redesign to ensure that is becomes embedded in the service organizational culture.

"Heavy users" is a new term often used to describe those who occupy a disproportionate number of psychiatric beds. In this study we identified the heaviest 10% (193) inpatient service users in one London borough over a 6 year period and compared these with a control group of 400 ordinary inpatient users. A weighting index was used to combine frequency of admission with duration. Heavy users were diagnostically and demographically similar to ordinary inpatient service users and only differed by their extensive use of services, about 3 times more than ordinary users in terms of health care costs, during the measured year. Their heavy use mainly depended on occupying hospital beds, and their use of outpatient, day patient and community services was relatively light.

The article describes the management of akathisia by a mental health nurse (MHN) prescriber, working in partnership with the patient. A single-case design was used to evaluate this. It highlights three features: first, MHN can safely prescribe psychiatric medication in combination with concordance therapy. Second, the value base underpinning prescribing practice is partnership, honesty and choice for the patient. Finally, the pharmacological mechanism of antipsychotic medication, which contributes towards akathisia, requires further analysis.

Hypericum perforatum L. is the most commonly used herb for treating depression. Due to the popularity of this botanical, there is a potential for economically driven adulteration of St. John's wort (SJW) products. The goal of this study was to investigate SJW ingredients suspected to be adulterated based on simple preliminary HPTLC tests. Commercial samples were analyzed by HPTLC following the United States Pharmacopeia (USP) monograph methodology, with additional visualization under white light. A number of these samples presented odd methanolic solution colors and unconventional HPTLC fingerprints, suggesting the presence of other species and/or extraneous polar additives. To achieve identification and separation of the polar additives, a new reversed-phase HPTLC method was developed. The adulterants were identified as synthetic dyes in the amounts of 0.51 to 1.36% by weight. Identities of the dyes were confirmed by scanning densitometry and HPTLC-MS. A modified USP method with additional detection mode permitted the identification of eight SJW samples adulterated with dyes and six others with flavonoid fingerprints different from those specified by USP from a total of 37 samples of dry extracts, finished products, and bulk raw herb. A decision flowchart is proposed to guide the detection of adulteration of SJW in a systematic fashion.

Aims and MethodMental illness may cause specific problems in the environment of an international airport. The aim of our study was to assess frequency, presentation and safety implications of mental disorders requiring formal admission at an international airport. We performed a retrospective study over 4 years including patients who were detained by the police and admitted.ResultsThe frequency of admissions was one per million passengers, the frequency of incidents raising safety concerns was four per 10 million passengers. An in-flight disturbance occurred in 1.4 per 10 million arriving passengers. Most common were schizophrenia or schizotypal disorder (46.8%) and mania (22.6%). Twenty per cent of patients presented with wandering.Clinical ImplicationsEmergency admissions and incidents causing safety concerns were rare. Airport wandering was a frequent presenting sign that should be recognised.