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BackgroundNeurological soft signs are subtle but observable impairments in motor and sensory functions that are not localized to a specific area of the brain. Neurological soft signs are common in schizophrenia. It has been established that soft signs meet two of five criteria for an endophenotype, namely: association with the illness, and state independence. This review investigated whether soft signs met a further criterion for an endophenotype, namely familial association. It was hypothesized that if familial association were present then neurological soft signs would be: (a) more common in first-degree relatives of people with schizophrenia than in controls; and (b) more common in people with schizophrenia than in their first-degree relatives.MethodA systematic search identified potentially eligible studies in the EMBASE (1980-2011), OVID - MEDLINE (1950-2011) and PsycINFO (1806-2011) databases. Studies were included if they carried out a three-way comparison of levels of soft signs between people with schizophrenia, their first-degree relatives, and normal controls. Data were extracted independently by two reviewers and cross-checked by double entry.ResultsAfter screening 8678 abstracts, seven studies with 1553 participants were identified. Neurological soft signs were significantly more common in first-degree relatives of people with schizophrenia than in controls (pooled standardised mean difference (SMD) 1.24, 95% confidence interval (c.i) 0.59-1.89). Neurological soft signs were also significantly more common in people with schizophrenia than in their first-degree relatives (SMD 0.92, 95% c.i 0.64-1.20). Sensitivity analyses examining the effects of age and group blinding did not significantly alter the main findings.ConclusionsBoth hypotheses were confirmed, suggesting that the distribution of neurological soft signs in people with schizophrenia and their first-degree relatives is consistent with the endophenotype criterion of familial association.

Ethnicity is reported to be an important, but often ignored factor in psychopharmacology. However, recent advances in molecular biology and the vision of 'personalised medicine' have spurred a debate on the role of ethnicity in this field. This paper reviews literature on the role of race and ethnicity in psychopharmacology. Despite considerable controversy on what the concepts of ethnicity and race actually measure, they are considered as important proxies for a person's culture, diet, beliefs, health behaviours and societal attitudes. Research has shown ethnic differences in the clinical presentation, treatment, clinical response and outcome of mental illnesses. A number of ethnically specific variations have been found in the genetic and non-genetic mechanisms affecting pharmacokinetics and dynamics of psychotropic drugs, which might underlie the previously mentioned differences in drug use and response across ethnicities. Although some of these ethnic differences could be partially explained by genetic factors, a number of ethnically based variables like culture, diet and societal attitudes could potentially have a significant, but as yet unquantified influence as well. Future research needs to address the problems with defining and accurately measuring 'ethnicity', as well as focus upon conducting studies that could guide treatments for people from diverse backgrounds.

We demonstrate a greater presence of ADHD symptomatology in SCZ compared to that reported for ADHD in the general population. Our findings highlight the importance of improved clinical assessment and treatment considerations in a subgroup of patients with SCZ.

In multicultural settings, personal beliefs, perceptions, and values are likely to influence psychiatric practice. A training program on cultural aspects of mental health could help improve awareness and sensitivity of these issues and the quality of care.

Purpose -This paper aims to investigate trainee doctors' experience of clinical audits and to explore solutions for identified problems. Design/methodology/approach -Psychiatry trainees from all the deaneries in the UK were invited to participate in a semi-qualitative online survey. It focused on estimating the quantity and quality of the clinical audits done by the trainees, exploring their experience and possible solutions for identified problems. Descriptive statistics and framework analysis were used to analyse the data. Findings -A total of 2,267 audits were carried out by 504 respondents. Of the respondents, 42 per cent completed at least one audit-cycle. Nearly half of the audits were presented locally and 37 per cent were submitted to the local audit departments. Recommendations from two-thirds of all the audits went unnoticed because of inadequate dissemination and implementation. Suggestions for improvement included: formal training, participation by non-medical colleagues, emphasis on quality of audits rather than quantity, and better co-ordination by audit departments. Practical implications -Trainees identify that local audits do not result in service improvement. Suggested changes may lead to improved effectiveness of the local clinical audit programmes. Originality/value -Audit activities by the trainee doctors lay the foundation of their involvement in clinical governance later on. To the best of the authors' knowledge, this study is the first of its kind to capture the clinical audit activities by the trainee doctors at the national level in the UK.

about prescribing practices, and invited doctors, all above F1 training level, to complete this by email. We emailed 120 doctors and received 72 completed questionnaires; 52.1% of the respondents were female, 53.4% had more than 6 years' experience as a doctor and 66.0% had prescribed to non-patients. Of that last group, 93.3% did not inform the person's regular general practitioner, with 95.0% feeling it was unnecessary to do so. The most commonly prescribed medications were antibiotics (77.3%), followed by analgesics (25.0%) and the oral contraceptive pill (18.2%). Of note, a number of respondents stated that they had prescribed sleeping pills (16.8%) and smoking cessation medications (8.5%). Most doctors felt it appropriate to prescribe antibiotics, analgesics and inhalers, and some felt it was acceptable to prescribe the oral contraceptive pill and antipsychotic medication, to family and friends; 58.9% admitted to selfprescribing. Although the majority of doctors had used private prescriptions, approximately a fifth had used National Health Service prescriptions (21%). Finally, 55.3% reported never reading the GMC guidelines on prescribing. Our results show that a large proportion of doctors are not adhering to GMC guidelines on medication prescribing. In many cases this may be attributable to simply not reading the guidelines. We suggest that the GMC considers publicising its prescribing guidance more widely to ensure good medical practice and to avoid the consequences of escalating poor prescribing habits.

AimsAripiprazole is an anti-psychotic medication widely used for bipolar affective disorder and depression. It's primary mechanism of action is as a partial dopamine agonist. Aripiprazole's effect on dopamine signalling in the mesolimbic and mesocortical pathways may lead to impulse control disorders, as seen with other dopamine agonist medications. Aripiprazole is often chosen by prescribers because of its favourable side effect profile. There is a need to synthesise the available epidemiological literature on the potential association between aripiprazole use and impulse control disorders. This is needed to inform patients and prescribers of the best available evidence regarding this potential association. Our aim is to conduct a systematic review of the available non case-study evidence on the potential association between aripiprazole and impulse control disorders.MethodDatabases were searched using MEDLINE, PsychINFO, EMBASE, Cochrane Clinical Trials and Web of science. All studies from no earliest date to December 2020 were included; adult patients with a severe and enduring mental illness prescribed antipsychotic medication were included. Cinician diagnosis, structured interview diagnosis, and interviewer or self-completion questionnaires were used to measure prevalence. The study designs included were experimental designs, cohort study, cross-sectional survey and administrative databases. Exclusion criteria being those with traumatic brain injury, psychosis secondary to autoimmune, iatrogenic, chromosomal or metabolic disorder, those with Learning disability or Autistic Spectrum disorders. studies with majority of participants <18yrs. Those who were on other antipsychotic medications in addition to Aripiprazole, were excluded. To ensure quality assurance, we used ROBINS-I tool and GRADE assessment to measure the risk of bias.Result240 records were retrieved, 187 after duplicates were removed. 8 full text articles were assessed for eligibility, of which 4 were included in the qualitative synthesis. 2 studies were analyses of spontaneous adverse drug reaction reporting systems and 2 of health insurance claims databases. All 4 studies found aripiprazole to be associated with greater risk of impulse control disorders. The single study which compared directly with other antipsychotics had a much smaller effect size. Study heterogeneity precluded meta-analysis. All studies were at high risk of bias. The quality of evidence is very low.ConclusionThe available evidence is consistent with the existing warnings regarding increased risk of impulse control disorders in patients prescribed aripiprazole. Clinicians may wish to monitor for this adverse drug reaction. Further research which can account for potential confounders, examines specific impulse control disorders and which is less susceptible to detection and ascertainment biases is required.