SummaryThis article gives an overview of the profile of Alzheimer's disease, its pathophysiology and recent developments in technology that enable better understanding of the mechanism of disease. The diagnostic criteria and role of biomarkers proposed are explained. The new subgroups described are outlined in table form for easy reference. Subtypes of mild cognitive impairment (MCI) are reviewed and the conversion of amnestic MCI to Alzheimer's disease is considered. The implications and change to current clinical practice form the basis of the conclusion of the article.

A 19-year-old white British man, not previously known to psychiatric services, presented with acute onset of florid psychotic symptoms. His symptoms included auditory hallucinations, misidentification of family members, thought interference and delusions of control. His level of distress was high and did not respond to verbal or medical de-escalation; therefore, he required nursing in seclusion. It was noted that he recently had an increase of his anti-epileptic medication to 100 mg topiramate twice per day. Topiramate was thought to be the cause of his psychosis and, consequently, was changed to phenytoin. Since discontinuation of the topiramate, his psychotic symptoms settled within 4 days and he was discharged shortly afterwards. He was monitored by the Early Intervention services. At 15-months post-discharge, there was no recurrence of any symptoms despite not receiving antipsychotic medication. To our knowledge, this is the first report that describes the progress of a patient past the initial psychotic episode. Therefore, we believe this is an important finding to report.

In adolescents admitted to mental health inpatient units, restrictive interventions are associated with a risk of physical and psychological harm. Mental Health policy and legal frameworks advocate least restrictive options and there is a drive to reduce the use of restrictive interventions in inpatient units. There is insufficient evidence pertaining to the characteristics of UK adolescents who are at risk of experiencing restrictive interventions within general adolescent mental health units. This study aimed to determine whether demographic and clinical characteristics are associated with the use of restrictive interventions or with the type of restrictive interventions. A retrospective cohort study was conducted using routinely collected data from a general adolescent unit in the National Health Service (NHS) in England, UK, over a 2-year period (1st January 2021 to 31st December 2022). There were three key findings. Of the 122 adolescents admitted, 46(38%) experienced restrictive intervention. Characteristics associated with the increased use of restrictive interventions included diagnosis of behavioural and emotional disorders and being a child looked after by the local authority. Being male was significantly associated with seclusion and being a child looked after was significantly associated with the use of physical and chemical interventions. These findings have important implications for policy and practice; they highlight the need for careful consideration by professionals, as to whether the needs of adolescents with these particular attributes are indeed best met within an inpatient unit, or whether the risks of admission including the increased risk of restrictive intervention outweigh the potential benefits. Also, further consideration of the most appropriate strategies for reducing restrictive interventions when admissions are appropriate or unavoidable, is required.

Eating disorder services worldwide were impacted by the COVID-19 pandemic experience, including its associated counter-measures. We examined the effect of the pandemic on sociodemographic and clinical characteristics of young people assessed and admitted by a specialist adolescent eating disorder service in the Northwest of England (UK). Routinely collected electronic data in the two years following the World Health Organisation declaration of a global pandemic in March 2020, was compared with data collected in the preceding two years. This service experienced a 21% increase in assessments from the two years pre-COVID (n=78) to the two years following the pandemic onset (n=120), Inpatient admissions also increased by 10%. The pandemic had no effect on admission setting, with approximately 20% admitted to specialist eating disorder units, 40% to paediatric wards and 40% to adolescent mental health units, consistently across the four years. No significant difference in sociodemographic characteristics of young people within the service before or during the pandemic was found. However, self-rated eating disorder pathology at assessment was significantly more severe following the pandemic. Fewer admission had a recorded comorbid diagnosis of an Autistic Spectrum Condition following the pandemic compared to those admitted pre-pandemic. These findings quantify the increase in demand for highly specialist adolescent eating disorder services since the start of the COVID-19 pandemic, with a higher severity of psychopathology managed outside of hospital. This has implications for service design, allocation of resources and future delivery of appropriate models of care to young people.