It was noted that approaches to the assessment and management of individuals intoxicated with alcohol who express suicidal ideation varied widely. This study explored what guidance is currently available and sought the opinions of 218 junior and senior psychiatrists.

The Royal College of Psychiatrists has no specific guidelines on this issue, but the Medical Defence Union and Scottish Central Legal Office gave opinion regarding a psychiatrist's duty of care and clinical responsibilities. This information did not reflect the opinions of the psychiatrists canvassed. There was no consensus among the 65% of clinicians who responded to the survey.

There is a need for greater clarity and guidance on the management of individuals who are intoxicated and express acute suicidal ideation. Sharing of good practice guidelines and greater integration of local and national policies is needed. It is certainly a topic worthy of inclusion in all induction days for junior psychiatrists.

To look at whether the opening of a day programme for the intensive care of people with severe anorexia nervosa in Leicester had the expected impact on admission rates, length of stay, cost of treatment and also simple measures of whether patients got better. Is this day programme an effective resource?

Since the opening of the day programme, in-patient bed days and overall costs of treatment for local patients have been reduced, and the early results in terms of weight gain and readmission rates are promising.

With many areas planning to set up eating disorder services for local patients, it is important to consider which are the best resources to invest in. The experience of a well-established specialist service in Leicester has shown that a day programme can be an enriching and cost-effective way to treat patients with anorexia nervosa, but that it does not replace the need for the availability of in-patient beds.

Brief or missed seizures might indicate that electronvulsive therapy (ECT) is not being delivered effectively. This cycle of audit at an ECT clinic aimed to measure rates of brief or missed seizures in two study periods, before and after the acquisition of a more powerful ECT machine.

There was a significant reduction in the rate of brief or missed seizures in audit two. There was a significant increase in the restimulation rate in audit two, but without the desired effect of inducing adequate seizures.

Ineffective delivery of ECT might result in poor response to the treatment and should be minimised. Certain aspects of ECT delivery improved in the clinic studied but some patients received an ineffective second dose of electrical charge.

The study aims to describe the experience of an assertive community treatment team when commencing clozapine at home rather than in hospital, following a locally-devised policy. Any failed attempts and problems experienced are described.

There have been no serious adverse events with 13 patients who have been started on clozapine at home.

For an assertive community treatment team, home-initiation of clozapine is a practical option, particularly when patients refuse to come in to hospital.

To develop a guideline that would encourage a systematic approach for both psychiatrists and general practitioners in the provision of safe, effective and consistent management of patients who are prescribed lithium. A multi-disciplinary working group developed the guideline following literature review and consultation with lithium clinics and specialist centres nationally.

The Lothian lithium guidelines include three sections: (a) a lithium treatment plan; (b) advice for clinicians on managing lithium levels; and (c) pointers for counselling patients on lithium. The treatment plan is a key document in the guidelines which, once completed, ensures continuity of care with the transfer of patient-specific information.

This development has provided the opportunity for primary and secondary care services to work together in producing a guideline that will improve patient care and minimises risk.

Three cases are described to illustrate the elective use of etomidate in electroconvulsive therapy (ECT) anaesthesia.

Use of etomidate is described in an individual who was treated with an electrical stimulus at the maximum level for the ECT machine in use; in a person who had severe side-effects with an alternative induction agent; and in a person with severe cardiac disease.

The anaesthetic drug should be tailored to the individual needs of the person being treated with ECT. Clinics should involve local anaesthetic departments in reviewing their anaesthetic practice.