Objective To investigate if an innovative clinical pathway for managing child and adolescent mental health (MH) ED presentations reduces average length of stay (LOS) and improves carer satisfaction. Methods An intervention feasibility study at an ED. Participants were 5–17 years olds presenting with MH problems and their carers. ED medical officer (MO) led Kids Assessment Liaison for Mental Health (KALM) clinical pathway was implemented as an intervention and it was compared to Care as Usual pathway which involved ED MO and MH clinicians. Data were collected via the ED clinical data system and a carer survey. Data were analysed by using SAS v9.4 (SAS, Cary, NC, USA). Survey was compared using Fisher's exact test and LOS was compared using median quantile regression. Results Fifty (23%) patients used the KALM pathway and 169 (77%) the Care as Usual pathway. The median (min, max) LOS in hours for those on the KALM pathway was 4.13 (0.46, 11.55) compared to 5.09 (0.21, 19.12) for Care as Usual pathway (P = 0.1407). Fewer patients breached the National Emergency Access Target (NEAT) when the KALM pathway was used (56%, n = 28 vs 64%, n = 108, P = 0.252). There were no significant differences in the carer survey between the two care pathways. Conclusion This study provides valuable information about the benefits of the KALM pathway in managing child and adolescent MH presentations to ED. This new pathway reduces the LOS in ED and improves carer experience compared to the usual care pathway.

Rates, demographics and diagnostics, which are the focus of many studies of suicide, may provide an insufficient account without adequate consideration of psychological, social and cultural contexts and motives. Furthermore, reported explanations of suicide are shaped not only by events but also the relationship of survivor respondents explaining the suicide. An explanatory model interview for sociocultural autopsy has been used to assess underlying problems and perceived causes. This study in a low-income community of Mumbai in 2003Mumbai in -2004 compared accounts of the closest family survivors and more distant relationships. Our study design distinguished series-level agreement (i.e., consistency of accounts within a group) and case-level agreement for particular cases. Serious mental illness was the perceived cause reported by a respondent in either group for 22.0% of index suicides, but case-level agreement was only 6.0%. Regarding financial stressors, more closely related family respondents focused on acute stressors instead of enduring effects of poverty. Caselevel agreement was high for marital problems, but low for other sources of family conflict.Tension was a feature of suicide reported in both groups, but case-level agreement on tension as a perceived cause was low (kappa = .14). The role of alcohol as a perceived cause of suicide had high series level agreement (46.0% in both groups) and case-level agreement (kappa = .60), suggesting comparable community and professional views of its significance. The study shows that it is relevant and feasible to consider general community patterns and particular survivor interests. Findings from this study recommend an approach to sociocultural autopsy to assess reasons for suicide in community studies. Findings clarify diverse views of underlying problems motivating suicide that should be considered to make mental health care more effective in assessing risk and preventing suicide.-3 - Keywords:India; psychological autopsy; sociocultural autopsy; survivor accounts; urban mental health; cultural epidemiology -4 - BackgroundIt is important to understand the reasons for suicide, so that efforts to prevent it are well-grounded and guided by locally relevant motivations, and so that an appreciation of community-reported reasons for suicide may contribute to the broader interests of mental health in services and community action. Although rarely considered, It is also important to recognize that explanations of suicide are likely to be influenced by the perspective of whoever is explaining it, and preferred explanations may reflect professional values, personal relationships to the deceased, and the level of available details concerning a behaviour with complex determinants (Jacob, 2008;Phillips, 2004). Mental health professionals concerned with suicide prevention typically focus on the role of high-risk psychiatric disorders (Goldsmith, Pellmar, Kleinman & Bunney, 2002; Harris & Barraclough, 1997), because their training and professional priorities sugges...

This study demonstrates the value of an approach to sociocultural autopsy examining local contexts and explanations of suicide. Findings highlight needs for both mental health services and culturally sensitive social interventions.

This is a report of a case of recurrent depression with hypertension, ischemic heart disease and diabetes mellitus which switched to mania while on escitalopram. Escitalopram, one of the newer selective serotonin reuptake inhibitors (SSRIs), is considered to have fewer adverse effects and a lower propensity for drug interactions. However, escitalopram may induce mania at a maximum dose of 20 mg especially when given with Alprazolam which is known to boost efficacy of SSRIs.