We report anti-N-methyl-d-aspartate (NMDA) receptor encephalitis in two patients with autism and intellectual disability presenting with neuropsychiatric symptoms of catatonia and neuroleptic malignant syndrome. Case reports such as these help raise awareness of this clinical issue. By paving the way for earlier diagnoses they ultimately maximise the potential for curative treatments and prevention of long-term complications.

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Health care pathways are a relatively new approach to delivering care in intellectual disability services. This study aimed to ascertain and explore successes and challenges in the implementation of care pathways in a National Health Service (NHS) adult intellectual disability service in Leicestershire, United Kingdom. Data were obtained from a variety of sources including observations of multidisciplinary team (MDT) meetings, issue logs and feedback from health professionals. Constant comparative analysis identified 10 themes; communication between health professionals; clarity and dissemination of relevant documentation; multidisciplinary working; role of health professionals; role of administrative staff; locality differences; information technology systems, care pathway procedures, attitudes towards care pathways and impact on patients. Successes and challenges in the implementation of care pathways and of health service changes more generally are discussed.

Specialist intellectual disability inpatient units have come under increased scrutiny, leading to questions about the quality of service provision in this sector. A care pathway-based approach was implemented in such a unit and its impact on outcome variables was measured. The care pathway-based approach resulted in the turnover of more patients, increased capacity for admissions to the unit, reduced lengths of stay in hospital, timely assessments and treatments, which resulted in better outcomes in patients. Care pathway-based approach to service provision provides not only better outcomes in patients but also a reliable way of ensuring true multi-agency working and accountability. If used widely, it can reduce the variability in the quality of current service provision.

Non-medical prescribing is increasingly utilized in clinical care and UK Standards have been produced for this. This study was undertaken to investigate compliance with these standards which were adopted by one mental health service and to review whether any changes were necessary to existing arrangements monitoring this compliance. A questionnaire was distributed to all 24 non-medical prescribers from one UK Mental Health Trust. Participants were asked to respond to questions about demographic data and prescribing practices. We also asked them to rate their experience on a 5-point scale. In all, 83% of non-medical prescribers responded. The UK Standards were met even though there was a shortfall in the uptake of training and supervision. Non-medical prescribers from the Community Drug Team and Older People's Service prescribed a narrow range of speciality drugs than any other category of drugs, but prescribed more often. UK Standards were met by the majority of non-medical prescribers. However, concerns were noted about a shortfall in training, supervision and experience of some non-medical prescribers. Conflict with psychiatrists was reported but their availability for support when necessary was valued. Non-medical prescribers believed that their input with non-medical prescribing had benefited patients.