It has been compulsory to wear face masks in all public spaces, both indoor and outdoor, since May 21, 2020 throughout Spain [1], a measure intended to prevent the spread of coronavirus disease 2019 (COVID-19). However, there are some exceptions to this rule, including “… People for whom the use of a mask is inadvisable for duly justified health reasons, or who, due to their disability or dependency, present behavioural alterations that make its use unviable.”

The need for support and participation in treatment of relatives to voluntarily and compulsorily admitted patients was addressed in a study of the quality of mental health services in two Swedish county councils. The aims of the study were to investigate differences in the above aspects between subgroups of relatives, the differences between two years of investigation, 1986 and 1991, and the differences between relatives of voluntarily and compulsorily admitted patients. The relatives investigated consisted of 79 spouses, 118 parents and 31 grown-up children. The results showed that there were only minor differences between the subgroups concerning their participation in care. Grown-up children experienced significantly less need of support and received less help for this need. In 1991, relatives participated more in the care situation, were more interested in support with regard to their own life situation, and also showed more positive attitudes towards the psychiatric services than in 1986. The relatives of the voluntarily admitted patients felt more involved in the patient's treatment, whereas the relatives of those compulsorily admitted felt less involved and perceived obstacles to admission.

Appraisal of caregiving and its relationship to family burden and experienced mental health problems in the relatives were investigated as part of a multi-centre study of the quality of mental health services in Sweden performed in 1997. The sample was drawn from relatives of involuntarily and voluntarily admitted patients to acute psychiatric wards. The instrument used was a semi-structured questionnaire, interviewing relatives about the burden, experience of mental health problems and appraisal of the caregiving situation. The results showed a high proportion of relatives engaged in caregiving activities on a daily basis the month before the patient's admission to hospital and a high proportion of relatives appraising the caregiving activities negatively. The burden was more extensive if the relative and the patient were living together, had a longer duration of their relationship, if the relative was rendering caregiving on a daily basis and if the relative appraised caregiving negatively. The relatives' psychological distress was not related to their negative appraisal of caregiving, nor was patient characteristics, such as diagnosis and level of psychosocial functioning. The only factor found to influence the relatives' psychological distress was the duration of relationship to the patient. Interventions reducing psychological distress for relatives who have known the patients for more than 20 years, who live with the patient, who give care on a daily basis and who appraise their caregiving negatively are suggested.

In recent years, the effect of Toxoplasma gondii infection on the cerebrum and neuropsychiatric patients has been increasingly highlighted. However, there is limited information about the epidemiology of T. gondii infection in psychiatric patients in Shandong province, eastern China. Therefore, through a case-control study, 445 patients hospitalized for diacrisis or treatment in Weihai, eastern China, and 445 control subjects from the general population of the same region matched by gender, age, and residence were examined with enzyme-linked immunoassays for the presence of IgG and IgM antibodies to T. gondii and associated sociodemographic and behavioural characteristics in a population of psychiatric patients. Seroprevalence of IgG antibodies to T. gondii in psychiatric patients (77/445, 17·30%) was significantly higher than in control subjects (55/445, 12·36%) (P = 0·038). Fourteen (3·15%) psychiatric patients and 10 (2·25%) control subjects had IgM antibodies to T. gondii (P = 0·408). Multivariate analysis using logic regression showed that T. gondii infection was associated with cats at home and consumption of raw/undercooked meat in psychiatric patients. Considering that most psychiatric patients usually have lower cognitive functioning and additional transmission routes related to their inappropriate behaviours that could enhance the risk of infection, psychiatric patients should be considered as a specific group of T. gondii infection.

The aim of this survey was to investigate the voting practices of patients on an acute psychiatric unit in the General Election 2011. Our survey showed that only 10% of patients voted and many patients were unaware of their right to vote. We recommend that all patients should be routinely informed of their right to vote as part of their hospital admission. Voting should be facilitated by hospital staff and advocacy where practicable.

Smoking is widely known as an architect of well-documented, negative health outcomes. The advent of legislated actions to ban work- and public-place smoking has reduced the overall smoking prevalence in Canada and around the world. However, what is often overlooked are patients with psychiatric illness who are confined in psychiatric institutions and are not able to take advantage of designated smoking areas. The aim of this commentary is to raise awareness of potential inequitable conditions that are inherent in workplace smoking restrictions particularly for psychiatric patients. A biological and social equity perspective will frame the discourse of the issue.

Aims – A narrative review of studies on the information needs of psychiatric patients, the knowledge of their diagnosis and treatment expectations. Methods – A literature review, limited to studies between 1980 to 2003, was carried out using Medline and Psychlnfo databases. Results – Sixty five studies of interest were identified. Less than half of the psychiatric patients know their diagnosis and patients affected by schizophrenia are the least informed. Notions about aetiology and treatment are patchy, and the concept of ‘multifactorial cause’ seems unknown. Little knowledge emerged about drugs and side effects, expecially in the long term. Patients want to be informed, involved in decisions and their treatment programme. They feel that their psychiatrists are more interested in pharmacological aspects than in their personal problems. Conclusions – A better quality of communication, the involvement of patients in decision processes and meeting patients' information needs is necessary to improve therapeutic relationships, to encourage greater compliance with treatment programs and to reduce the stigma of psychiatric illness.

Declaration of Interest: none of the three authors has had any interest or received any form of support, including that from drug companies and honoraria for lectures and consultancies, potentially in conflict with this scientific work.

Objective and Setting - The mortality of patients admitted to the General Hospital Psychiatric Ward of Pavia, Italy was studied for the period 1.1.1986-31.12.1991. Main outcome measures - Mortality was assessed using the standardized mortality ratio. The number of observed deaths was compared by sex, age group and cause of death with the number of expected deaths if the general population mortality of the same area were applied to our sample. Results - The result of this comparison was that the mortality through inpatients was three times higher than that of the general population. This overmortality has been observed with respect to natural causes of death as well as to unnatural causes. Particularly deaths from circulatory diseases, mental disorders and deaths by injuries and poisoning are overrepresented in both sexes.

Objectives: Although epilepsy and psychiatric disorder are known to be associated, little is known about the nature of epilepsy in psychiatric inpatients and how well psychiatrists manage psychiatric patients with epilepsy. The aim of this study was to describe the nature of epilepsy in patients at a large specialist independent psychiatric hospital and to audit the management of epilepsy using patients' records.

Method: Cross-sectional survey of inpatients and audit of clinical documents. Audit standards were derived from good clinical practice and UK guidelines.

Results: In total, 83/488 (17%) patients had a life-time history of epileptic seizures and 67 (14%) were receiving anti-epileptic drugs. The prevalence of epilepsy was 37% among brain injury patients, compared with 10-11% in adult male and female forensic patients and in the elderly and 2% in adolescents. Generalised tonic-clonic seizures predominated. Common aetiological factors were: traumatic brain injury, antipsychotics, cerebral hypoxia, cerebrovascular disease and learning disability. In 53/67 (79%) cases the care plan stated the patient had epilepsy but in only 20 (30%) was the seizure type recorded. For 30 (45%) there was no history of how epilepsy had been diagnosed. Of those patients with a history of status epilepticus, 5/15 (33%) had a readily accessible emergency treatment plan. The patient's last seizure was incompletely documented in 29/44 (66%) cases, while for only 7/67 (10%) patients was there documented evidence of a review of epilepsy management within the past year.

Conclusions: Epilepsy was common in this group of psychiatric inpatients. Documentation and management needed improvement and to be in line with national guidelines.

Aims – Psychiatric patients often are not informed about their diagnosis and their involvement in the decision making process is rare. Aim of the study was to explore the informative needs of patients with schizophrenia and the knowledge about their illness. Method – Three focus groups were conducted with 25 long-stay patients with the diagnosis of schizophrenia, attending the Mental Health Centre of the South-Verona Community-based Mental Health Service. The group discussions were audiotaped and transcribed. Results – The authors identified 18 different thematic categories which were used by two raters to classify all patient contributions. The interrater reliability was satisfactory. The qualitative analysis evidenced that patients have little knowledge about their illness. Patients had confuse and vague ideas on schizophrenia but their knowledge on drug names, dosages and side effects appeared precise and detailed. Several patients have looked for information in encyclopedias and medical dictionaries. Conclusion – The findings suggest a need of patients affected by schizophrenia for an information exchange with their psychiatrists that takes into account their informative needs, corrects wrong beliefs and actively involves them in therapeutic decisions.

Psychiatric patients suffer high rates of mortality and morbidity. One of the major reasons for this is the high prevalence of physical health problems in psychiatric patients. Psychiatrists have tended to pay less attention to, and receive less training in, the management of the physical health of their patients with this role largely being left to general practitioners. Though there is an increasing awareness of long term physical morbidities in psychiatric patients, the literature on acute physical morbidity is sparse. In this article we aim to emphasise the importance of recognising serious physical illnesses that could arise in the acutely unwell psychiatric patient.

The scope of this article is not to provide a comprehensive list of physical complications and management strategies but to provide the psychiatrist with a conceptual framework to assist with the management of co-morbid physical and psychiatric illness.

Objectives: The aims of this study were to identify the social and clinical needs of patients attending an inner city psychiatric service, to examine the relationship between need and various demographic and social parameters, and to demonstrate the usefulness of the Camberwell Assessment of Need (CAN) in an Irish population.

Methods: A random sample of patients was selected from a census of patients attending the Mater Hospital (Dublin) sector psychiatric service on March 1, 1997 for inclusion in the study. Needs were assessed using the Camberwell Assessment of Need.

Results: Fifty-seven patients agreed to participate in the study. The mean number of needs identified by patients was 2.14 (+/− 2.09) and by staff 1.92 (+/−1.18). There was a high level of correlation between staff and patients. The areas where patients most frequently expressed a need were ‘psychological distress’, ‘company’, ‘physical health’, ‘information’ and ‘looking after the home’. Eighteen patients (32%) identified needs that were not being met.

Conclusions: This study confirms the usefulness of the Camberwell Assessment of Need in the identification of clinical and social needs in psychiatric populations and demonstrates its usefulness in an Irish population.

Objective: To quantify the number of patients absent without leave (AWOL) from an Irish psychiatric hospital in one year and to examine the clinical and demographic data of this group of patients.

Method: This was a retrospective study of all patients reported as AWOL from St Brendan's Hospital in 1991. The following information was obtained from the patients' case notes: age, sex, legal status, marital status, psychiatric diagnosis, number of previous admissions, past history of absconding, length and outcome of absence. Their clinical and demographic variables were compared with a control group of 214 patients (non-absconders) randomly selected from the hospital admissions over a 12 month period.

Results: A total of 48 patients absconded. The majority were male, single, compulsorily detained, with a past history of absconding. The most common psychiatric diagnoses were schizophrenia (32%), personality disorder (23%) and alcohol dependence syndrome (17%). While absent, three patients had a history of suicidal behaviour and four became involved in criminal activity. Compulsory status was statistically significant when compared to the control group.

Conclusion: The characteristics of our group of absconders are similar to those in previous studies apart from the increased prevalence of personality disorder and alcohol dependence syndrome. We discuss the risks associated with absconding and recommend close follow-up of this group of patients.