Trends in the number of restricted patients in England and Wales 2003-2016: Implications for forensic psychiatry services.

This paper uses data produced by the Ministry of Justice to look for trends in the numbers of various categories of patients detained under the Mental Health Act in England and Wales between 2003 and 2016. Specifically, we have focussed on patients detained with Ministry of Justice restrictions in place. The number of 'restricted' patients, who are largely detained in secure psychiatric hospitals, has risen substantially during this period. If this trend continues, there will be the need for further expansion of secure psychiatric beds in the years ahead. Factors driving the increased number of restricted patients are discussed in this paper.

The 'honeymoon effect' and 'gate fever' in a secure forensic adolescent psychiatric hospital: Do they exist?

There is limited research that comments on whether there are recurring patterns for incidents or significant events during inpatient admissions to psychiatric units. This is even more so the case for an adolescent population. This study looked at 30 consecutive female patient admissions to Bluebird House, a medium secure adolescent unit in the South of England, to identify whether both the 'honeymoon effect' (low incident rate in the first 28 days following admission) and 'gate fever' (high incident rate in the last 28 days prior to discharge) were identifiable phenomena. Analysis of the incident rate found that in our secure adolescent population, the number of incidents both in the first week and at the first 28 days was higher in comparison to the whole admission. We also did not find a consistent increase in incidents in the final 28 days of the admission.

Vitamin D status of adolescent inpatients in a secure psychiatric hospital.

OBJECTIVE: The objective of the study was to use routinely collected data on vitamin D levels of adolescents detained in a secure psychiatric hospital to see if this at-risk group for vitamin D deficiency do in fact have low vitamin D levels. METHODS: Vitamin D blood levels were collated from clinical records of inpatients admitted to Bluebird House, a medium secure adolescent unit, since 2012. Corresponding data were gathered to include gender, ethnic status and age. Blood levels were assessed on admission to the unit and after treatment with vitamin D supplementation, if indicated. RESULTS: Only 3 out of the 35 patients (8.6%) had adequate vitamin D levels (serum 25-hydroxyvitamin D [25-OHD] > 50 nmol/l). A total of 23 patients (65.7%) had levels consistent with deficiency (25-OHD < 30 nmol/l) with the remaining 9 patients (25.7%) showing levels indicating possible deficiency (25-OHD 30-50 nmol/l. CONCLUSIONS: Vitamin D levels were low in our sample of young people admitted to a secure psychiatric hospital. This is the first published study of vitamin D levels in a secure adolescent psychiatric hospital. The results point to the need for routine prescription of vitamin D to adolescents held in secure conditions such as hospitals, secure children's homes and youth offender institutes.

Large de novo deletion of 7p15.1 to 7p12.1 involving the imprinted gene GRB10 associated with a complex phenotype including features of Beckwith Wiedemann syndrome.

We present an infant with a de novo cytogenetically visible interstitial deletion of approximately 21.9Mb involving chromosome bands 7p15.1-7p12.1, with the loss of 119 genes confirmed by array CGH. The infant had a ventricular septal defect, hand and skull anomalies, and hyperglycaemia compatible with haploinsufficiency of TBX20, GLI3, and GCK genes, respectively. In addition, the infant had some features reminiscent of Beckwith Wiedemann syndrome including macroglossia, umbilical hernia, and a relatively large birth weight and we speculate that this is due to the deletion of GRB10, an imprinted gene on chromosome 7. This report illustrates how knowledge of genes within a deleted interval facilitates optimal medical management, can explain observed phenotypes, and stimulates research questions.