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Treatment guidelines identify few adequately powered trials to guide recommendations for anorexia nervosa. To evaluate the effectiveness of three readily available National Health Service treatments for adolescents (aged 12-18 years) with anorexia nervosa. Multicentre randomised controlled trial of 167 young people comparing in-patient, specialist out-patient and general child and adolescent mental health service (CAMHS) treatment. Each group made considerable progress at 1 year, with further improvement by 2 years. Full recovery rates were poor (33% at 2 years, 27% still with anorexia nervosa). Adherence to in-patient treatment was only 50%. Neither in-patient nor specialist out-patient therapy demonstrated advantages over general CAMHS treatment by intention to treat, although some CAMHS out-patients were subsequently admitted on clinical grounds. In-patient treatment (randomised or after out-patient transfer) predicted poor outcomes. First-line in-patient psychiatric treatment does not provide advantages over out-patient management. Out-patient treatment failures do very poorly on transfer to in-patient facilities.

Young people with anorexia nervosa are often admitted to hospital for treatment. As well as being disruptive to school, family and social life, in-patient treatment is expensive, yet cost-effectiveness evidence is lacking. Cost-effectiveness analysis of three treatment strategies for adolescents with anorexia nervosa. UK multicentre randomised, controlled trial comparing in-patient psychiatric treatment, specialist out-patient treatment and general out-patient treatment. Outcomes and costs assessed at baseline, 1 and 2 years. There were 167 young people in the trial. There were no statistically significant differences in clinical outcome between the three groups at 2 years. The specialist out-patient group was less costly over the 2-year follow-up (mean total cost 26 738 UK pounds) than the in-patient (34 531 UK pounds) and general out-patient treatment (40 794 UK pounds) groups, but this result was not statistically significant. Exploration of the uncertainty associated with the costs and effects of the three treatments suggests that specialist out-patient treatment has the highest probability of being cost-effective. On the basis of cost-effectiveness, these results support the provision of specialist out-patient services for adolescents with anorexia nervosa.

Over the last decade, CBT has been found to be an effective alternative to medication for people with psychosis. Although consensus around the essential elements for CBT has been reached (Morrison & Barratt, 2010) the study also highlighted the idiosyncratic nature of the principles of CBT to the presenting problem and suggested consensus around specific CBT strategies may differ amongst experts if the symptom was specified, for example, persecutory delusions or hallucinations. A randomised case series was designed to investigate whether entering a feared situation and dropping safety behaviours led to a greater reduction in distress and belief in feared outcome ratings than exposure alone for people experiencing persecutory delusions. Over five sessions, participants were invited to complete assessment measures, develop a case formulation and complete two ten minute behavioural experiments involving exposure alone and exposure with dropping safety behaviours. In total, 5 participants completed all the assessment data and 3 participants completed the final experiment. As hypothesised, all participants reported a feared outcome associated to their persecutory ideation and all participants reported safety behaviours associated to their feared outcome. Study two employed a Delphi methodology to seek consensus amongst experts on the essential elements of CBT for persecutory delusions. The experts were invited to rate statements over three stages, covering many principles such as assessment, formulation, change strategies, homework, therapist assumptions and relapse prevention. Overall, 82 statements were rated as essential or important for CBT for persecutory delusions by > 80% of the panel, with 20 statements reaching a consensus of 100% at stage two. People experiencing persecutory delusions do report using safety behaviours and the safety behaviours are associated with a feared outcome. Although no conclusions could be drawn as to whether dropping safety behaviours produced a greater reduction to distress and belief, people are open to experimenting with dropping their safety behaviours.

One of our tenants is about to move into an amazing flat in Clink Street, SE1, which was used as a location in Bridget Jones' Diary and is let for pounds 1,800 a week. He calls to confirm his flight details from the US so I can organise a chauffeur. \"One small thing,\" he says. \"I forgot to tell you about my shotgun collection.\" I gently break it to him that British gun laws are rather tougher than he's used to and point him to the Home Office website where he'll find the licence application forms. He will also need a secure gun cabinet screwed onto the wall, which the landlord may not want in his newly refurbished flat. I'd better get in touch with him quickly.