The Narrowing Temporal Apertures for Clozapine in Treatment-Resistant Schizophrenia
This article has not been peer reviewed. It proposes a conceptual model supported by converging observational evidence and clinical reasoning. Treatment-resistant schizophrenia affects approximately 20–30% of individuals with schizophrenia. It …
The Great Training Robbery: Why Lessons Are Not Learnt
Every NHS trust maintains a mandatory training matrix. Staff are tracked, chased, and occasionally threatened until compliance rates hit the target — typically 85% or above. The annual study day …
The Ockenden Report – a tale of pathogenic system failures
The Ockenden Report, published on 24 June 2026, lays bare the human cost of systemic failure. It examines maternity services at Nottingham University Hospitals NHS Trust (NUH) over more than …
Consent after McCulloch: where clinical judgement meets patient choice
Why clinicians should care about this case? Many clinicians know that consent is important. Fewer appear to know how much the law of consent changed after Montgomery v Lanarkshire Health …
The ICD-11 Clinical Descriptions and Diagnostic Requirements (CDDR) sets out the diagnostic criteria for schizophrenia under code 6A20 with admirable clarity. At least two symptoms from a list of seven, at least one drawn from the core positive group — persistent delusions, persistent hallucinations, disorganised thinking, or experiences of influence, passivity, or control. Symptoms present …
CDDR, diagnosis, evidence, factors, ICD-11, organic, schizophrenia, substances
Assessing Formal Thought disorder in practice
TheEditor
Formal thought disorder (FTD) assessment in real-world psychiatric practice is in trouble. If you work in the NHS, you will have seen it: the words “No formal thought disorder” written in a clinical note, with no accompanying evidence that any such assessment actually took place. No verbatim speech. No description of the flow of thought. …
analysis, dementia, depression, diagnosis, diagnostics, FTD, schizophrenia, TALD, thought disorder
A Medical Mutiny and a Penal Trap
TheEditor
Step onto the residential wings of any British prison today, and you will quickly encounter a distinct class of prisoner. These individuals are not pacing their cells counting down the months to a fixed release date. Instead, they are living in a state of suspended animation, trapped under the legacy of the Imprisonment for Public …
crime, criminal, dspd, government, history, ipp, law, life-sentence, prison, prisoners, state
Different Devils, One Hand: The Genesis of Bad Law
TheEditor
In May 1991, a six-year-old girl was mauled in Bradford. Her name was Rukhsana Khan. The dog was a pit bull terrier. The injuries were terrible, and they were real. Within weeks, Parliament had a new law. The Dangerous Dogs Act 1991 passed at speed. It named breeds. It ordered destruction. It was meant to …
devil, dogs, homicide, law, mechanism, panic, people, sociology, suicide
The Last Line of Defence: Prescribing in the Gap Between Clinical Practice and Regulatory Expectation
TheEditor
Prescribing and a prescription are not the same thing. The prescription is the visible endpoint. A signed line. A ledger entry. A medication authorised. Prescribing is everything that must happen before that endpoint can properly be reached. A diagnosis must be formulated against recognised criteria. Authoritative clinical guidelines must be considered. Capacity must be assessed. …
diagnosis, GMC, law, legal, medication, psychiatry, regulation, regulatory, standards, treatment, wrapper
When Deference Becomes Deadly: The Accumulation That Killed Preston Davey
The death of thirteen‑month‑old Preston Davey, murdered just four months after his adoption, has prompted one of the most searching safeguarding reviews in recent years. In the weeks leading up …
GMC compliant psychiatric assessment and treatment plans
Every psychiatrist in the UK follows a well‑worn sequence when assessing a patient. Rapport first. History. Mental state. Formulation. Risk. Treatment plan. It is a clinical rhythm that is learned, …
Safe Prescribing Review: The Five Gates
This work contains a downloadable PDF document below. It is a working instrument, not a policy paper; a single-page crib sheet with explanatory guidance, for structured individual or team review …
Why the Oliver McGowan Case Still Matters
On 11 November 2016, Thomas Oliver McGowan, an 18-year-old man with epilepsy, mild autism, a mild learning disability, and cerebral palsy, died at Southmead Hospital in Bristol. He had been …
New options arising from the RCPsych new CPD Guidance
The Royal College of Psychiatrists’ January 2026 CPD guidance introduces a minimum requirement of 30 clinical CPD hours per year, removes any specified minimum for non-clinical activity, and confirms that …