To compare the clinical characteristics and psychiatric management of antipsychotic nonadherence among outpatients with schizophrenia who either do or do not have current or past comorbid substance use disorders, a national survey was conducted of psychiatrists engaged in the management of schizophrenia. Respondents reported on the presentation and management of one adult patient who had been under their care for at least 1 year and who had been nonadherent with oral antipsychotic medications at some point in the last year. The response rate was 69.3%. Patients with schizophrenia only (N = 190) were compared with patients with schizophrenia and a history of a co-occurring substance use disorder (N = 105). Approximately one third (35.6%) of antipsychotic nonadherent schizophrenia patients had a comorbid substance use disorder. Denial of illness was the most commonly cited primary reason for antipsychotic nonadherence. Psychiatrists were significantly less likely to discuss with comorbid patients than patients without comorbid substance use linkages between antipsychotic adherence and progress toward personal goals (64.5% vs. 78.9%), and significantly less likely to explore the meaning of taking medication to the patient's identity (59.2% vs. 73.3%). However, psychiatrists were approximately two times more likely to add another antipsychotic for patients with substance use disorders (22.8% vs. 11.0%). There were no perceived differences between the two groups in effectiveness of interventions to manage medication nonadherence. Comorbid substance use disorders are common among psychiatric outpatients with schizophrenia who are nonadherent with antipsychotic medications. Some psychological approaches tend to be used less often with patients with comorbid substance use disorders, although when they are used, psychiatrists report they are no less effective than they are for schizophrenia patients without comorbid substance use disorders. These findings suggest that some psychological interventions may tend to be underutilized in the management of medication nonadherence among patients with comorbid schizophrenia and substance use disorders.

Anecdotally, forensic psychiatric nurses generally have a more negative perception of people diagnosed with a personality disorder and this negativity is focused more towards managing the behaviours rather than on treatment efficacy and clinical outcomes. This study reports on research carried out across the High, Medium and Low secure psychiatric services in the UK. One thousand two hundred questionnaires were distributed with a response rate of 34.6%. The results indicated a statistically significant difference across High (z = 9.69; P < or = 0.01), Medium (z = 11.06; P < or = 0.01) and Low (z= 9.57; P= 0.01) security with a focus on the management of people with a personality disorder using the Wilcoxon paired samples test. There was also a statistically significant difference in relation to a more clinical/treatment focus for those with a diagnosis of mental illness in Medium (z = 9.69; P < or = 0.01) and Low (z = 9.57; P < or = 0.01) security but not in the High security services. Finally, the results showed significant differences between High, Medium and Low security on each of the four scales of Personality Disorder Clinical-Personality Disorder Management and Mental Illness Clinical-Mental Illness Management. This raises issues of stigma, prejudice and discrimination and suggests a refocus on skills development, acquisition and application for those with a label of personality disorder.

This paper reports on a study of nurses' and non-nurses' perceptions of labels of mental illness and personality disorder in forensic services in the UK. The objectives of the study were to establish if differences in perceptions existed within, and between, the two groups of professionals. The research method was a survey design with 1,200 questionnaires distributed to nurses and 300 to other professionals in disciplines on forensic units in the UK, with response rates of 34.6% and 43%, respectively. The target population included clinical health care staff who had patient contact, including nurses, psychiatrists, psychologists, social workers, and occupational therapists. The results indicate that there are statistically significant differences within both nursing and non-nursing groups and also between the groups in relation to a "management" perspective for individuals labelled with a personality disorder and a "clinical" focus for individuals who are labelled as mentally ill. This paper adds research into the arena of forensic mental health in relation to the diagnostic labels of mental illness and personality disorders. It also adds evidence of a clinical response or a management response to such diagnostic labels which may impact on the practice of forensic psychiatry.

Vertebro-basilar insufficiency produces a rich spectrum of psychological and neurological symptoms. Where psychological symptoms dominate the picture, the patient may be presented first to a psychiatrist. The phenomenology of vertebro-basilar insufficiency is discussed with special reference to hallucinatory syndromes, memory disturbance, affective disorders, akinetic mutism, ‘unusual reports’, cortical blindness, agitated delirium, the Capgras syndrome and normal pressure hydrocephalus. Finally, the case of a 61-year-old man illustrating a variety of the neurological and psychological features described in this paper is presented.

People with intellectual disabilities generally have poorer health outcomes compared with those who do not, including outcomes related to nutrition‐related non‐communicable diseases. Carers support people with intellectual disabilities in many aspects including habitual shopping and preparation of food, but their own nutrition knowledge and the influence this may have on dietary intakes of clients is unknown. We explored the nutrition knowledge of carers of people with intellectual disabilities in residential care settings, their dietary habits and their influence on clients' food shopping and preparation and therefore the diet consumed by their clients. Ninety‐seven carers belonging to a large independent care sector organisation specialising in the care of people with an intellectual disability completed a validated general nutrition knowledge and behaviour questionnaire. Seventeen carers from the residential care settings were interviewed to contextualise practice. Knowledge about key dietary recommendations scored highly. Carers who had more work experience were found to have higher scores in ‘making everyday food choices’ (p = 0.034). Daily consumption of fruit and vegetables (at least one portion per day) was observed (for fruit by 46% of the carers and for vegetables by 60% of the carers), whilst most carers reported avoiding consuming full‐fat dairy products, sugary foods and fried foods. The concept of a healthy diet; typical dietary habits of clients; role in food acquisition; and training in nutrition emerged as themes from the interviews. Carers discussed various topics including the importance of a balanced diet, cooking fresh foods and control of food portion sizes for clients relative to the care philosophy of a client‐centred approach, which encapsulates client autonomy. Gaps in knowledge around specific nutrients, making healthy choices and cooking skills remain. Carers have an influence on clients' dietary choices; they are able to provide healthy meals and share good dietary habits with clients. Further training in nutrition is recommended for impact on clients' health.