Impulsivity appears to be contributed to by both impaired neuropsychological function and 5-HT function. Impaired neuropsychological function alone makes a contribution to aggression. Treatment needs to take account of the neuropsychological and biochemical deficits in this challenging population.

Attachment theory should be used to inform the design and delivery of general mental health services. Mental health services should evaluate the extent to which they meet service users' attachment needs. Attachment-informed mental health services should assess outcomes, including cost-effectiveness over time. Papers included in this review focus on long-stay residential care or secure services and there is a limited experimental evidence base to show that providing an attachment-informed service improves patient outcomes.

No abstract

This study was part of an evaluation of a Clinical Decision Support Tool (CDST) which was developed as the basis for the Integrated Packages Approach to Care (InPac) model for adult mental health services in South West Yorkshire Mental Health NHS Trust (SWYMHT).The study investigated the use of the CDST and its potential impact on service users and carers through the standardisation of patient's needs assessments and care packages. Focus groups for service users and carers were held to discuss their perspective of the impacts of the CDST in routine use. Thematic analysis of the group discussions suggests that service users and carers believe the CDST has some potential benefits for service users, carers and staff, yet to date, it has had little direct impact on service users. The study identified a number of areas where service users and carers believed the tool could be improved in order to increase its effectiveness in routine clinical practice.