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
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 is characterised by inadequate response to at least two adequate trials of different antipsychotics. Clozapine remains the only antipsychotic with robust evidence of benefit in …
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 is booked. The e-learning is clicked through. The tick goes in the box. And then, overwhelmingly, nothing changes. This pattern is not unique to the …