Repeat users of crisis resolution and home treatment team.

CRHT services have reduced admissions to psychiatric hospitals. Some patients use CRHT services repeatedly. We reviewed the first 30 patients who were repeat users of the CRHT services, Luton, between 1 August 2010 and 31 July 2011. The repeat users were a small group of patients needing disproportionately large amounts of resources from the CRHT service. The factors associated with repeat use of CRHT were past psychiatric admission and the diagnoses of emotionally unstable personality disorder, self-harm behaviour and substance misuse. Identifying the factors leading to repeat CRHT use could lead to providing a more tailored service and reduce repeat use of these services. It appears that repeat CRHT service use might be the result of the interaction of a wide range of factors relating to underlying disorder, substance misuse, self harm behaviour, employment status and social support. It is also important to note that many of the patients are liable to relapse as they go through stressful life situations, despite adequate medication and psychosocial intervention. It can be difficult to identify all the factors that contribute to a pattern of repeat presentation to CRHT services. However, identification of such factors might help clinicians to offer more targeted services and might also assist commissioners in focusing resources effectively. They might need more intensive community-based programs to identify and treat the relapses. The CRHT teams should include all the appropriate professional disciplines required to provide community care for these challenging service users.

Secondary enuresis & body dysmorphic disorder in a caucasian male with catatonic schizophrenia: a case report.

We describe a patient with Schizophrenia and secondary enuresis. The enuresis settled with resolution of his psychotic symptoms but later remerged after starting Clozapine. We explore the mechanisms of incontinence in Schizophrenia and those due to Clozapine. This case highlights the need to inquire about incontinence in patients with schizophrenia prior to prescribing clozapine.