To investigate whether psychiatrists' views of the Mental Health (Care and Treatment) (Scotland) Act 2003 had changed over time, we repeated our survey of psychiatrists' views and experiences of the Act, 1 year after our original study; 356 College members were surveyed by postal questionnaire.

A response rate of 66% was achieved. More than half (53%) of respondents were reasonably satisfied with the Act and 51% would choose to use it in preference to the previous Act. the majority (89%) felt that their daytime workload had increased as a result of the Act; 17% received payment for Mental Health Act-related work.

Satisfaction with the Act has improved since its introduction; however, areas of concern remain.

We hypothesised that the proportion of people referred to two outer London mental healthcare services for older people with cognitive impairment increased after the 2001 National Institute for Health and Clinical Excellence (NICE) guidelines for acetylcholinesterase (AChE) inhibitor use in Alzheimer's disease, but declined after the amended 2006 guidelines. We reviewed case notes for 546 individuals referred between 1999 and 2007.

The proportion of individuals with cognitive impairment referred increased between 1999 (56.1%) and 2005 (70.5%, χ2=5.4, P=0.02), as did the proportion prescribed AChE inhibitor (0.8% to 16.1%, χ2=27.5, P<0.001). There were no significant changes between 2005 and 2007.

The 2006 NICE amendment may have curbed the increase in psychiatric referrals and AChE inhibitor prescribing rates for people with cognitive impairment but so far these rates have not decreased.

To ascertain the prevalence of epilepsy and understand the differences in the comorbidities of non-epileptic and epileptic patients with learning disabilities. A simple comparative survey was undertaken between the two main groups of patients: non-epileptic and epileptic.

The prevalence of epilepsy in the study group was 30%. A total of 70% of patients with any type of challenging behaviour were in the non-epileptic group compared with 59% in the epileptic group. Depression was the most common diagnosis in both groups, being slightly more in the non-epileptic group.

Our study suggests that there is no association between epilepsy and the prevalence of challenging behaviour of psychiatric conditions within the learning disabilities population.

To compare local practice with national guidelines, examine the areas of divergence, and establish complication rates for methadone and diamorphine. Fifty-one patients from Cornwall treated with injectable methadone or diamorphine were interviewed using a standard questionnaire.

Fewer problems were reported by individuals using injectable diamorphine, though for both drugs intramuscular injection was more problematic than intravenous injection. Injections into the groin were common, as was problem drinking.

Intramuscular administration of medications may be more likely to cause abcesses or cellulitis. Ongoing groin injecting and alcohol misuse is common, but should probably be tolerated if other harm reduction benefits accrue. It may be prohibitively expensive to set up injecting rooms in rural parts of the UK and future policy should reflect this.

Specialist registrars in psychotherapy, at various stages of their training, attended a 1-day experiential group relations conference. The aim was to provide a training context in which trainees could reflect, through direct experience, on their capacity for leadership and teamwork, and the difficulties in taking up one's own authority in role.

Participants rated (on a 5-point Likert scale) the various structured elements of the conference as being greater than moderately useful for their learning. At 9-month follow-up, median scores were 4, indicating that the conference had a moderate to high impact on the participants' learning in four key dimensions: effective communication, taking up a leadership role, dealing with task-and role-related anxiety, and containing others' psychological projections.

There is often little time to reflect on one's experiences or behaviour in professional environment. The study demonstrates that learning about one's behaviour, capacity for leadership, performing various roles and the ability to act with authority, in a facilitated experiential learning environment can make a significant contribution to the development of future consultant psychiatrists in psychotherapy. In the light of the new curriculum (Royal College of Psychiatrists, 2006), this training model may facilitate the achievement of core and general competencies for all trainee psychiatrists.

A questionnaire survey of all memory clinics in Scotland to obtain information about clinic characteristics, assessment techniques and prescribing practice.

Memory clinics are a common component of old age psychiatry services within Scotland. There is variability in clinic characteristics, assessment techniques and treatment approaches. Most clinicians appear to rely on their own clinical judgement rather than national guidelines when making decisions about investigations and the prescription of anti-dementia medications.

There is considerable variation in memory clinic practice across the country. Would standardisation of practice ensure equity in service provision/patient care? However, would such standardisation be at the cost of clinical autonomy?

To examine service-level variables predicting treatment adherence in a specialist eating disorder unit. We analysed a sample of 157 individuals consecutively referred to the unit over an 18-month period. Associations were determined using odds ratios.

Individuals with a formal care programme at the point of referral were more likely to stay in treatment. Treatment adherence was not predicted by illness severity or waiting time. Follow-up by a dietician and acceptance of referral to a support group predicted better treatment outcomes.

Although the standard care programme approach may be relinquished in the UK, we recommend that this approach or its equivalent be used in specialist eating disorder services to improve treatment adherence.

We examined the impact of a crisis resolution and home treatment teams (CRHTT) on hospital admission rates, bed days and treatment satisfaction among older people with mental illness and their carers. We compared these factors in the 6 months before the service started and 6 months after its introduction.

The CRHTT significantly reduced admissions (P<0.001), but there was no significant difference in the length of hospital stay as compared before and after the introduction of this service. There was a trend towards carers, but not patients, being more satisfied with treatment after the introduction of the CRHTT.

The CRHTT reduced hospital admissions for older people by 31% and carers preferred the service. Further research on crisis teams in older people with mental illness is needed using randomised controlled methodology.

This study examines the prevalence of vitamin D deficiency in a group of male psychiatric in-patients and follows 16 of them prospectively during treatment with calcium and ergocalciferol tablets.

Of 17 male patients, 15 had vitamin D deficiency and two had borderline deficiency. Vitamin D deficiency was associated with Black and minority ethnic background. Improvement in vitamin D status was observed following replacement therapy.

Vitamin D deficiency may be widespread in the psychiatric population particularly in Black and minority ethnic but also in White European in-patients. Vitamin D level should be routinely monitored in psychiatric in-patients. for those with vitamin D deficiency, replacement therapy can be commenced with calcium and ergocalciferol tablets (containing 10 μg of ergocalciferol), which is safe and well tolerated. All psychiatric in-patients should have adequate exposure to sunlight and attention to diet to ensure that they receive their recommended daily allowance of vitamins and minerals.