Doctors' holding power in practice: section 5(2) of the Mental Health Act 1983.

Section 5(2) of the Mental Health Act 1983 (England and Wales) is a commonly used short term power of detention often implemented by junior medical staff, which has no statutory right of appeal. There is little published analysis of its use in clinical practice. A detailed case note study of its use in a psychiatric service with a large catchment area is presented. Fifty-seven per cent of the patients detained under s.5(2) were female. Affective psychosis was over-represented in detained females, while schizophrenia and paranoid states were over-represented in males. Eight per cent of s.5(2) detentions were initiated via the nurses' holding power, s.5(4). None of these patients were subsequently regraded to s.2 or 3, which may be accounted for by the finding that personality disorder and alcohol dependence were more commonly diagnosed in this subgroup. Of s.5(2) detainees, none of those with a non-psychotic disorder were regraded to s.2 or 3. Three patients had not accepted in-patient admission prior to implementation of s.5(2). Moreover, 38 per cent of all s.5(2) detentions took place within 24 hours of admission. Patients with a psychotic disorder were more likely to be detained within 24 hours of admission. Doubts regarding the validity of consent to voluntary admission in these patients are raised.

Schizophrenia in old age (late paraphrenia).

Late paraphrenia is the form of expression of schizophrenia in old age. Twenty five patients diagnosed as suffering from the condition were studied, and their symptoms compared with the diagnostic criteria for schizophrenia of Spitzer et al (1975), the Catego system (Wing et al, 1974), Carpenter et al (1973a) and Langfeldt (1960). The study confirms late paraphrenia as one of the schizophrenias, and discusses differences with previous studies.