General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms AbstractAims Personality disorder is increasingly categorised according to its severity, but there is no simple way to screen for severity according to ICD-11 criteria.We set out to develop the Standardized Assessment of Severity of Personality Disorder (SASPD). Methods110 patients completed the SASPD together with a clinical assessment of the severity of personality disorder. We examined the predictive ability of the SASPD using the area under the ROC curve (AUC). Two to four weeks later 43 patients repeated the SASPD to examine reliability. ResultsThe SASPD had good predictive ability for determining mild (AUC =0.86) and moderate (AUC=0.84) PD at cut points of 8 and 10 respectively. Test retest reliability of the SASPD was high (intraclass correlation coefficient = 0.93, 95% CI = 0.88 to 0.96). ConclusionThe SASPD provides a simple, brief and reliable indicator of the presence of mild or moderate PD according to ICD-11 criteria. Declaration of interest:Peter Tyrer chairs the ICD-11 advisory group for the World Health Organization. Roger Mulder and Mike Crawford are also members of the group. 3

Narcolepsy is a lifelong sleep disorder characterized by a classic tetrad of excessive daytime sleepiness with irresistible sleep attacks, cataplexy (sudden bilateral loss of muscle tone), hypnagogic hallucination, and sleep paralysis. There are two distinct groups of patients, ie, those having narcolepsy with cataplexy and those having narcolepsy without cataplexy. Narcolepsy affects 0.05% of the population. It has a negative effect on the quality of life of its sufferers and can restrict them from certain careers and activities. There have been advances in the understanding of the pathogenesis of narcolepsy. It is thought that narcolepsy with cataplexy is secondary to loss of hypothalamic hypocretin neurons in those genetically predisposed to the disorder by possession of human leukocyte antigen DQB1*0602. The diagnostic criteria for narcolepsy are based on symptoms, laboratory sleep tests, and serum levels of hypocretin. There is no cure for narcolepsy, and the present mainstay of treatment is pharmacological treatment along with lifestyle changes. Some novel treatments are also being developed and tried. This article critically appraises the evidence for diagnosis and treatment of narcolepsy.

Benign cystic renal teratomas are uncommon clinical entities in our environment. To the best of our knowledge, it has never been reported here. Renal teratomas are rare and most have been dismissed as retroperitoneal teratomas secondarily invading the kidney. We report a case in which benign cystic renal teratoma was associated with ipsilateral hydronephrosis, urinary tract infection and spontaneous abortion, with histological confirmation in a 25-year-old woman.

SummaryCatatonia is a common but underrecognised complication of bipolar disorder, with a quarter of in-patients with bipolar disorder developing catatonia. Almost 9 million people in the UK are deaf or have a significant hearing problem and British Sign Language is the preferred language of 50 000–70 000 people within the UK. Between 1 and 2% of these individuals (i.e. the same as in the rest of the population) will experience bipolar disorder in their lifetime and therefore the accurate diagnosis of catatonia is important. We report a case of catatonia presenting with dysphagia in a woman who is profoundly deaf–mute and who has bipolar disorder. This report highlights some modifications of presentation and difficulties of accurate diagnosis and management of catatonia in this patient. To the best of our knowledge, this is the first case report of catatonia in someone who is profoundly deaf–mute.

A collaborative approach where the clinician, the patient and the relative(s) participate in the memory-screening tests is advised. Some relatives may benefit from counselling.