Key elements of a new model of governance would specifically include the following An extensive, continually updated data resource on the evidence around the off-label use of psychotropics for all patient groups led by the MHRA. Routine documentation of medical indications in the prescribing process, as required practice for clinicians. A research programme, possibly in a new Medical Research Council Centre, and certainly supported by NICE and the Cochrane Collaboration into clinically driven off-label uses, focused on the most regularly prescribed psychotropic medications. Amendments to the Daporinad clinical trial licensing process to allow updated good quality evidence from

non-RCT research to inform and influence Inhibitors,research,lifescience,medical the provisional licensing of add-on indications. This model of research and prescribing governance would benefit and protect both patients and prescribers, and take forward the contribution of pharmaceutical researchers and manufacturers in a key area of drug repurposing. Footnotes Inhibitors,research,lifescience,medical Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. St Andrew’s Healthcare, a not-for-profit registered charity which provides psychiatric treatment, funds the St Andrew’s Academic Centre and its staff. Inhibitors,research,lifescience,medical Conflict

of interest statement: The authors declare no conflict of interest in preparing this article. Contributor Information Philip Sugarman, Chief Executive Officer, St Andrew’s Healthcare, Northampton, UK. Amy Mitchell, St Andrew’s Healthcare, St Andrew’s Academic Centre, Northampton, UK. Catherine Frogley, St Andrew’s Healthcare, St Andrew’s Academic Centre, Northampton, UK. Geoffrey L Dickens, St Andrew’s Healthcare, Inhibitors,research,lifescience,medical St Andrew’s Academic Centre, Northampton, UK. Marco Picchioni, St Andrew’s Healthcare, St Andrew’s Academic Centre, Billing Road, Northampton, NN1 5BW, UK.
We report the case of Ms S, a 25-year-old law student who was admitted to our hospital in January 2011 for emergency treatment

for psychotic symptoms. The main symptoms were disorders of thought content, i.e. a marked systematized delusion, Inhibitors,research,lifescience,medical with persecutory delusions and delusions of reference, and hallucinations: her flat was bugged, the tap water was poisoned, second animals were telling her where to go and she incessantly heard birds chirping. No other psychopathological abnormalities were present and, in particular, cognition and consciousness were not impaired, so that there was reasonable support for a psychotic disorder. At the time of admission, Ms S had no known history of mental illness. There was no relevant family history, apart from a diagnosis of bipolar disorder of her 2-year-older brother. Ms S reported a history of occasional alcohol consumption but denied consuming drugs or smoking. The physical examination at admission found moderately severe acne on the back and face, preferentially localized on the forehead.