Purpose -High-secure hospital patients often have complex presentations that are marked by co-morbidity, violence, histories of poor concordance with oral medication, and treatment resistance. The ability to give a long-acting medication with a low propensity for extra pyramidal side effects is of potential value to clinicians treating these patients. Risperidone Long-acting Injection (RLAI) is the first long-acting atypical antipsychotic medication and may be potentially useful in this population. This paper aims to investigate this issue.Design/methodology/approach -This was a retrospective, naturalistic study to investigate the use and effectiveness, using hard outcome measures, of RLAI in the four UK high-secure psychiatric hospitals. Hospital pharmacy databases at Ashworth, Broadmoor, Carstairs and Rampton hospitals were used to identify all patients who had been prescribed RLAI. Anonymised data were then obtained from the pharmacy databases and case notes which were then pooled.Findings -A total of 159 patients were prescribed RLAI, most of whom had schizophrenia. The mean length of treatment with RLAI was 65 weeks (range two to 260 weeks) and the mean maximum dose was 43.2 mg every two weeks (range 25-75 mg every two weeks). No serious adverse effects were reported. In total, 42 per cent (67) patients responded to RLAI in as much as that they either remained on it in the long-term or were discharged to conditions of lower security whilst taking it. As there was no control group, it is not possible to determine if RLAI was a significant factor in such discharges to conditions of lower security. Of those patients who failed to respond to RLAI, 44 per cent were subsequently treated with clozapine.Originality/value -This pragmatic multi-centre study of a small but complex patient group demonstrated that RLAI was effective in 42 per cent of patients and was well-tolerated.

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Clinical phenomenology was developed in the twentieth century and has become increasingly utilized as a means of examining patients' experience and behavior in a rigorous and systematic way. A discipline conceptualized and propagated by Karl Jaspers (1883–1969), clinical phenomenology is part of day‐to‐day practice in psychiatry. Description of a patient's mental state using the phenomenological approach is termed descriptive psychopathology, which is formulated by use of the Mental State Examination ( MSE ). An MSE provides a framework of documenting the experiences of a patient to facilitate formulation of a diagnosis and a case conceptualization.