We recently completed an audit on cognitive testing used in routine practice within our Older People Community Mental Health Team in East Dorset, U.K. We measured the frequency of use of the Addenbrooke's Cognitive Examination (ACE) following its introduction as the baseline test for cognition, comparing it to the Mini-mental State Examination (MMSE) (Folstein et al., 1975).

The purpose of this case study was to use an evidence based medicine approach to work through an unusual way of treating a common problem. We looked at an example of an in-patient with severe refractory psychotic depression who had been resistant to treatment with a combination of antidepressant, antipsychotics, mood stabiliser, and concomitant ECT therapy.We then undertook a literature search for the use of clozapine in a patient with severe refractory depression.Although the resulting evidence was low level and thin, we felt on balance that a trial of clozapine was justified.We used a BPRS inventory to monitor her mood prior to commencing clozapine. Her mood and functional abilities were monitored as her clozapine was titrated upwards.Our patient showed a significant improvement in mood and functional abilities and a reduction in her BPRS score during this period. Her symptoms improved to the point where she was successfully discharged home on a combination of clozapine and an antidepressant.The improvement was sustained for a further two years.We thought this was an important case to highlight the limited evidence in using this successful form of treatment for a common clinical problem and that further research in this area was needed.

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This paper is a review article which has systematically gathered contemporary evidence, the best practice guidelines for the management, treatment of behavioural and psychological symptoms of dementia and the various approaches including pharmacological and non-pharmacological approaches. It sets out to outline the various types of behaviour in different subtypes of dementia and a practical approach for clinicians in managing these behaviours.