To conduct a survey on the frequency and severity of assaults by patients on psychiatric trainees, and the availability of training on managing violent patients; a self-report questionnaire developed in the USA was adapted to the Flemish situation. Data were collected from 99 psychiatric trainees from the Dutch speaking part of Belgium, representing a 60% response rate.

As many as 56% of the respondents had been confronted with at least one physical assault by a patient during their residency, whereas 72% had already been threatened by a patient. Only a small minority had received any training related to patient violence.

Some formal teaching or training in managing (potentially) violent patients should be incorporated in psychiatric training in Flanders.

A postal questionnaire was sent to consultant psychiatrists in the West Midlands to establish their current ward round practice. This questionnaire addressed ward round etiquette, practical issues and educational function. Consultants received only one mailing.

A total of 96 (out of 139) consultants replied (69% response rate). The majority of consultants saw patients on the ward round (97%) and all consultants introduced both themselves and team members to the patient; 72% explained the purpose of the ward round. A median of seven professionals attended the ward round with psychology (6.5%) and pharmacy services (0%) being underrepresented. When consultants added comments, the recurrent themes were that ward rounds were an effective use of professional time but were often daunting for patients.

Our results indicate some uniformity in the conduct of ward rounds. The lack of representation at ward rounds for certain professional groups may adversely affect the range of opinions and therapies for patients. Changes could be made to incorporate the views of users, which would make ward rounds more productive for users and professionals.

Despite good evidence for their effectiveness in the treatment of schizophrenia, family interventions are difficult to implement. Prior to a local trust-wide programme to encourage their use, we carried out a case note review of family contact with clients and staff of community mental health teams (CMHTs). A 10% sample of CMHT clients was included.

The majority (81%) of clients had been in contact with family or carers in the preceding year. In 88% of case files the carers were relatives. In 37% of cases care coordinators were in recent contact with carers, primarily by telephone. Evidence of any family intervention was recorded in 5% of case files and carers' assessments in 7%.

The majority of CMHT clients have some form of contact with their families, and care coordinators make informal links with these families. This contact could be reframed to encourage more formal family interventions.

To survey current specialist perinatal psychiatric provisions and opinion about these services in England. A brief semi-structured confidential questionnaire was circulated to the lead clinician or manager responsible for perinatal services of the 78 mental health trusts in England.

Fifty-seven trusts (73%) responded. In 26 trusts (46%), availability of either specialist in-patient facilities and/or intensive home treatment facilities were reported. In only 13 trusts (23%) was there evidence of provision of services covering both in-patient and community components. The number of mother and baby units or their equivalents has reduced in the past decade. The services were generally considered to be inadequate nationwide and opinion remains divided about the best approach for providing them.

There is a need for a recommendation of a national standard provision of perinatal services by mental health trusts.

To explore the role of the consultant psychiatrist using an observational approach. Five consultant psychiatrists were shadowed by a trained observer. Observations were subjected to a qualitative analysis based on a grounded theory approach.

Six themes emerged as being significant; these were administration and secretarial support; training aspects of the role; clinical activity; the referral process; supervision, support and continuing professional development; and organisational systems.

The results indicated significant difficulties in the role of the consultant psychiatrist and the need for change. Any change in this role would have an effect on the roles of other professionals and on the whole system in which they work.

To review the efficacy and safety of lithium augmentation for the management of clozapine-induced neutropenia. Medline search January 1966 to March 2004.

The ability of lithium to increase the white cell count (WBC) is well documented. A small number of published case reports of the successful treatment of clozapine-induced neutropenia with lithium were identified. Lithium does not protect against agranulocytosis.

Lithium may be useful in raising the WBC in patients whose baseline count is too low to allow treatment with clozapine to start and to protect against clozapine-induced neutropenia, thus allowing more patients to benefit from treatment with clozapine. It does not protect against agranulocytosis. There is no way of identifying patients whose neutropenia will progress to agranulocytosis. Careful monitoring is essential. Lithium is not licensed to increase WBC. Psychiatrists should be aware of the medicolegal implications of prescribing off-label.