Early intervention in psychosis [EIP] services, UK: a critical analysis of the evidence

The UK mental health reforms have attracted major government funding. This has been used to commission specialized community teams for people with severe mental illness. The reforms include changes to services for first-episode psychosis, which have gained huge consumer support. The UK service reforms are continuing, with the aim of providing services fit for the 21st century. In this article, we have reviewed the evidence which led to the establishment of early intervention services in the UK by using a selected review methodology. The review includes the historical background to EIP [Early Intervention in psychosis], what is EIP, where it originated from, what was the evidence leading stake holders to push the government to incorporate it in the National Health Policy. What policy reforms took place, and how the government went about implementing these services. We have discussed the current situation of the service. Furthermore we have discussed the gaps in the policy which have been identified. We end the paper with recommendations to policy makers

Which antipsychotics would mental health professionals from a low income country choose for themselves?

To determine which antipsychotics mental health professionals from a low income country would choose for themselves. Cross-sectional study. This study was conducted in 8 cities in Pakistan from February to August 2008. Responses from 268 mental health professionals, including psychiatrists and nurses were obtained using a semi-structured questionnaire. All together 80% of doctors chose an atypical antipsychotic; risperidone was the most popular choice. Half of nurses did not know which antipsychotic to choose and the remaining chose haloperidol [21%] and risperidone [19%]. Efficacy and safety were the two most important factors influencing their decision. Both doctors and nurses in Pakistan considered efficacy and safety/tolerability to be important factors for choosing an antipsychotic; this is in line with National Institute of Clinical Excellence [NICE] guidelines 2009. Mental health training for nurses was identified as a major service deficiency

Comparison of the personal health questionnaire and the self reporting questionnaire in rural Pakistan

To apply ROC analysis to select the best threshold scores for the PHQ and SRQ; to compare the sensitivity and specificity of the PHQ and SRQ against a criterion diagnosis of depressive disorder in a community sample in rural Pakistan, and to examine the influence of socio-demographic factors on misclassification. The study used a two-stage design. Receiver Operating Characteristic [ROC] analysis was used to estimate the optimal threshold score and to compare the ability of the Self Reporting Questionnaire [SRQ] and the Personal Health Questionnaire [PHQ] to discriminate between cases of depressive disorder and non-cases. The results of the ROC analysis suggest that the SRQ is superior to the PHQ, and at the threshold of 5/6, the SRQ has superior sensitivity, negative predictive value and percentage agreement compared with the PHQ. When the SRQ threshold is raised it gains specificity, and at a cut-off threshold of 7/8 it is superior to the PHQ [5/6] in all validity coefficients and percentage agreement. Only gender and the presence of a confidant had a significant effect on misclassification using the SRQ among the cases. Both questionnaires performed better for females based on comparison of the areas under the ROC curves. This study has demonstrated that the Urdu translations of both the PHQ and SRQ can be used as screening tests for depressive disorder in the Pakistani population. People with little or no education answer both somatic and psychological items with equal ease. In conclusion, the PHQ does not appear to have any advantage over the SRQ