Five cases of psychiatric illness, presenting as functional psychosis, occurring in male homosexuals with human immunodeficiency virus (HIV) infection are described and compared with similar cases in the literature. The association between psychosis and infection with HIV is discussed with particular emphasis on the significance of functional versus organic presentation.

No abstract

The object was to develop and evaluate a new concentrated model of psychiatric diversion scheme at the magistrates' court, designed to maximize the potential of such interventions. A one-year prospective study was undertaken of a consecutive series of 264 referrals to the new diversion project at an Inner London magistrates' court, with concurrent examination of police station custody records, magistrates' court returns, hospital admission data and remand prison transfer records for an area with a population of 500,000. The results showed that this one scheme originated 12.8% of all the unrestricted hospital orders in England under section 37 of the Mental Health Act 1983, 4.2% of section 35 orders, and 6.4% of section 48 and 48/49 remand prisoner transfers. Of all arrests in the central London area, 0.46% were referred to the scheme, with 0.28% being admitted. The seriousness of the charge did not have a significant effect on whether or not admission was achieved (p = 0.5365). The new model is a powerful intervention in the assessment and diversion of mentally disordered offenders. Similar supra-district diversion centres may have a role to play in other areas, complementing other local diversion exercises, some of which might better be relocated to the police station.

A 1-day audit (on 11 March 1985) of the psychotropic drugs prescribed for 1084 institutionalized adults with mental handicap in a long-stay hospital is reported. The relevance of staffing levels, chronological age, sex and mental level is considered. Of the 1084 patients, 35 per cent were 17-44 years old and 65 per cent were 45 years or older; 51 per cent were severely and 40 per cent were profoundly mentally retarded; 23 per cent received antiepileptic drugs; 22 per cent received antipsychotic drugs. The hospital's nurse:patient ratio was nationally recognized as among the worst in England. There was no evidence that a low staffing level was associated with a high level of antipsychotic drug use, but there was an inverse relationship to age, and to mental level. Significantly more women than men received antipsychotics/ anxiolytics, antidepressants or hypnotics/ sedatives.