To improve the quality of written communication between general practitioners (GPs) and community mental health team (CMHT) members concerning patients newly referred to two inner-city CMHTs. Following a benchmark audit of a random sample of referral and assessment letters, locally agreed good practice protocols were shared widely, accompanied by a dissemination and implementation strategy.

Significant improvements occurred in both GP and CMHT letters; these were most dramatic after 1 year, but tailed off considerably in the second year despite continued efforts to implement the protocols' standards.

Planned dissemination and implementation strategies can help to improve routine clinical communication between CMHTs and GPs through the use of good practice protocols, thus improving shared working between primary and secondary care providers.

The aim of this study was to determine the existence and extent of differences in prescribing practice for patients according to ethnic group, with two widely used atypical antipsychotics, olanzapine and clozapine. All in-patient prescription charts were screened and patients receiving olanzapine and clozapine identified. Dosage, antipsychotic co-prescription and race were recorded, along with demographic details, and evaluated using comparative statistical analysis.

Overall, 1441 prescriptions were screened; 328 patients received olanzapine and 200 clozapine. Details of ethnic origin were available for 287 of those prescribed olanzapine and 188 of those prescribed clozapine. There was no significant difference between ethnic groups in age or gender, for either drug. For clozapine, dosage and extent of antipsychotic co-prescription did not differ significantly between ethnic groups; for olanzapine, there was no significant difference in daily dose between the groups, but co-prescription was significantly more common in Black (33%) than in White patients (20%; P=0.023).

Important differences in the prescription of olanzapine and clozapine between ethnic groups are uncommon, but demand further investigation. Larger studies incorporating additional baseline details such as diagnosis and body weight are called for.

To evaluate a psychosocial intervention for patients treated with antipsychotics with body mass index (BMI) > 25. A total of 44 patients (mean age (s.e.) 37.6 (1.2); 28 female, 16 male) received dietary and exercise advice with motivational interviewing. Weight and BMI were measured at baseline and monthly thereafter. Patients were offered weight monitoring for 1 year.

Overall mean weight loss was 3.1 kg (mean 3.22%). Modal (range) weight change was 74.2 (719.2 kg to +8.7 kg).

Overall weight loss was not significant after 355.7 (32.5) (mean, s.e.) days. Determinants of response remain unclear. Avoiding weight gain in the first instance is critical. Further research will explore determinants of antipsychotic-induced weight gain and prevention strategies.

We aimed to determine the prevalence of childhood mental health problems in children of parents registered with an Australian area mental health service, and to study the parents' help-seeking and service use for their children. Parents were recruited through their case managers, and asked to complete the Strengths and Difficulties Questionnaire (SDQ), the Service Utilisation Questionnaire and the Help-seeking Questionnaire.

A quarter of the children were in the clinical range of the SDQ total scores, with high sub-scale scores. However, 63% of the parents reported reluctance to seek help, and 19% reported not using services.

Children of parents with mental illness are at higher risk of childhood psychiatric disorders. Assessment of the child at the time of referral of the parent is an opportunity for problem identification, parental education, and early intervention.

A pilot study was set up to compare a symptom-triggered ‘front-loading’ detoxification technique with the usual fixed dosage method. A group of 23 in-patients with alcohol dependence were randomised to receive either the intervention technique using diazepam or the standard chlordiazepoxide taper over 10 days.

The intervention group received a mean dosage of 74 mg diazepam (equivalent to 222 mg chlordiazepoxide) compared with 700 mg chlordiazepoxide in those receiving usual treatment. There was no statistical difference in the severity of alcohol withdrawal symptoms in the two groups, and the intervention group were slightly more satisfied with their treatment than the group undergoing the usual detoxification treatment. Feedback from the nursing staff was positive towards the new approach but highlighted some potential problems for its wider implementation.

It was possible to use a simple randomised trial design to introduce a new technique for alcohol detoxification to a specialist unit. Symptom-triggered front-loading detoxification using diazepam was as effective as a standard taper technique in terms of withdrawal severity reduction, and was acceptable to both patients and staff. This is potentially a useful technique for busy acute psychiatric wards.

This paper reports the evaluation of a pilot domiciliary phlebotomy service provided by an old age psychiatry service to enhance the management of patients in their own homes. Clinical and demographic data were collected and the costs of phlebotomy home visits compared with those of ambulance transport.

Of 511 phlebotomy visits made to 307 patients, only 8% were unsuccessful. A subgroup analysis indicated that 70% of patients would have been unable to leave home unaccompanied to attend for venepuncture. The cost of the phlebotomist's travel was comparable with the estimated cost of providing ambulance transport for patients who would have required it.

Domiciliary phlebotomy can be a viable method of performing blood investigations in an old age psychiatry service to support home assessment.

The project gathered data from a cohort of 300 flexibly trained female consultants in psychiatry in order to understand how their careers had progressed since the completion of their training. A postal questionnaire was used to gather this information.

These consultants were generally satisfied with their training, and were succeeding in pursuing their careers. Flexible training was developed to enable people with family commitments to train in psychiatry, and this is what it is being used for.

Flexible training is an important avenue for an increasing number of psychiatrists to continue in their profession. With the current shortfall in consultant numbers, flexible training should be maintained and developed, and should be seen as a useful route to a consultant position.

A questionnaire was sent to old age psychiatrists to ascertain their experience, views and clinical practice regarding psychological therapies in their services.

The provision of psychological treatments of all modalities to older people is widely varied in Britain. The main difficulty seems to be a lack of resources, but it would appear that inexperience with psychological therapies applied to older adults is also a factor. Most mental health teams (95%) provide anxiety management therapy, and cognitive–behavioural therapy is widely available (76% of teams), but areas such as training and staff supervision appear to be poorly provided.

Suggestions are made to increase provision and quality of service within existing resources; improving services to the standards of the National Service Framework would be a bigger challenge.

A prospective descriptive study was set up to evaluate the feasibility, acceptability and activity of an innovative weekly primary care service for patients admitted for acute psychiatric care.

During 10 months, 36 clinics were held and 123 appointments were attended. Presenting complaints included a wide range of acute and chronic conditions, affecting all body systems. As well as treating specific complaints, the doctor providing this service undertook considerable health promotion work and gave advice about patient management to junior psychiatrists.

It appears that there is considerable need for primary care expertise within an acute psychiatric unit, and that a weekly clinic is a feasible model of care.

All psychiatry trainees and supervisors on the Southeast Scotland scheme were invited to complete a questionnaire about the regularity, responsibility, structure, content and value of supervision.

Significantly more supervisors (87%) than trainees (69%) reported regular supervision. Some trainees still find it difficult to obtain regular supervision. Although it is seen as a joint responsibility, there is uncertainty about the role and responsibility of each trainee and supervisor. Most trainees and supervisors feel that supervision is useful, but supervisors are likely to rate their quality of supervision better than their trainees. Guidelines for the structure, content and boundaries of supervision might be useful. Supervision is viewed as useful for discussing clinical management, including the trainee's own case-load.

Training in the use of supervision should be available to all trainees and supervisors. Regular supervision should be a priority, and it is a joint responsibility to ensure that it happens. There should be greater accountability to the College and Trusts. Discussion of the trainee's clinical case-load during supervision is a necessary part of training and the supervision process.

To examine the effectiveness of integrating evidence-based supported employment into an early intervention service for young people with first-episode psychosis. Demographic, clinical and vocational data were collected over a 12-month period to evaluate the effect on vocational outcomes at 6 months and 12 months of the employment of a vocational specialist, and to assess model fidelity.

Following vocational profiling and input from the vocational specialist and the team, there were significant increases in the proportion of clients engaged in work or educational activity over the first 6 months of the intervention, and in a subsample over a second 6-month period. The evidence-based Supported Employment Fidelity Scale was used to measure the degree of implementation, which scored 71, signifying ‘good implementation’.

The results suggest that implementing evidence-based supported employment within an early intervention service increases employment and education opportunities for patients within the service.

The Record of In-Training Assessment grades of all registrars in the psychiatric specialties in the UK were analysed for each of three successive years, specialty by specialty, and compared with the average outcome for registrars in all disciplines over the same period.

Over 98% of psychiatry registrars were assessed as satisfactory, 1.2% needed targeted training and 0.7% were graded as unsatisfactory, requiring repeat training. Targeted training and repeat training led to a satisfactory outcome in the majority of cases.

The process of assessment needs to become more objective, and should do so as the Royal Colleges develop better measures of clinical competence.

The aim of this survey was to examine staff views on smoking at work in a large psychiatric hospital. A postal questionnaire was sent to all clinical staff (n=1471) asking about their smoking habits and attitudes to smoking at work.

The response rate was 40.7%. Overall, 22.0% of respondents were smokers, with unqualified nursing staff having the highest rate (31.0%). The majority of staff did not favour a total ban on smoking by staff, patients or visitors. Smoking habit and profession influenced responses. Smokers and nurses were more permissive in their attitude towards smoking on wards than non-smokers and psychiatrists.

Implementation of the government's recommendations on tobacco control in psychiatric units is likely to require considerable preparatory work with staff to ensure full compliance.

The Irish Psychiatric Association conducted a national survey of psychiatric services in Ireland to examine clinical resources in relation to the relative affluence of catchment areas. A consultant psychiatrist from each catchment area was sent a postal survey form (August 2002) and the data received were cross-referenced with measures of relative affluence.

There was a 72% response rate. A negative relationship emerged between indices of need and both the number of acute beds and the number of consultant psychiatrists per head of the population.

The results of this survey indicate that clinical resources in mental health in Ireland are not concentrated in areas of greatest need, but paradoxically have been best developed in areas of greatest affluence.

To evaluate a 50-place partial hospitalisation programme during its first year of operation. Data were recorded for consecutive referrals to the programme. Its effects on the admission unit were also assessed.

The unit received over 200 referrals over 12 months, and more than 60% were for individuals who might otherwise have been admitted. The programme was associated with reductions in number and duration of hospital admissions and in bed occupancy rate; however, the proportion of urgent referrals to the programme doubled over the year, and after 12 months the occupancy rate was 96%.

The programme was well received by clients and well used by clinicians. Although it initially reduced the pressure on in-patient services, the problems confronting the programme at the end of the evaluation mirrored those of in-patient units.

To assess the preferences of people attending a substance misuse facility towards the treatment options available for opiate dependency. Interviews were conducted using a card sorting technique.

The majority (60%) of the 101 participants believed that detoxification was superior to maintenance in preventing illicit heroin use. The preferred treatment options were oral methadone, buprenorphine, drug-free rehabilitation, in-patient detoxification and prescription of injectable drugs.

Both pharmacological and psychosocial options, including in-patient detoxification and rehabilitation, are among the treatments preferred by clients of substance misuse services. There is also a significant demand for both injectable drugs and dihydrocodeine.

To examine the prevalence and admission patterns of patients with personality disorder admitted to a Scottish general adult psychiatry service. We carried out a retrospective case-note study of patients identified from the computerised patient administration system. A subgroup of patients was identified as having a longer in-patient stay. Their admission pattern over the preceding 4 years was studied further.

Sixty-two of 844 patients admitted had personality disorder. Thirty-nine had a primary diagnosis of personality disorder, 19 had an additional diagnosis of psychiatric disorder and 12 of alcohol or substance misuse. Within the subgroup admitted for longer in 2001, patterns of few/brief and numerous/often lengthy admissions were noted in earlier years.

Personality disorder occurs in approximately 7% of admissions to general adult psychiatry beds. Many have additional diagnoses of psychiatric disorder, or substance or alcohol misuse further complicating their treatment.

Risperidone long-acting injection (RLAI) is the first atypical antipsychotic drug to be available in a ‘depot’ formulation. The evidence base underpinning its use is small. We sought to evaluate its early use in clinical practice by a naturalistic follow-up study of the first 50 patients to be prescribed RLAI in one National Health Service Trust.

At 6 months, 54% of patients had achieved at least minimal improvement, 4% were unchanged, 24% failed to comply, and 18% fared poorly and were switched to alternative antipsychotics. The attrition rate at 6 months was 42%. Supplementation with oral antipsychotics was often required for longer than 3 weeks. Only half of those who had a good clinical outcome at 6 months had achieved this by 3 months.

Some patients responded well to RLAI, but the overall attrition rate was high. Although RLAI provides additional choice in the range of treatments available for people with schizophrenia, we have much to learn about how to optimise its use in practice.

The aim of this study was to determine the attitudes of medical students in the UK towards different specialties as career options and to ascertain the position of psychiatry among these specialties. Students belonging to a London medical school completed a questionnaire.

Among the 301 students who completed the survey, psychiatry was the least popular clinical specialty. The study revealed that the students had a number of misconceptions about psychiatry. A family history of mental illness was significantly associated with choosing psychiatry as a career.

Considering the unpopularity of the specialty, it is likely that recruitment of psychiatrists will continue to be a major problem for the foreseeable future. Measures need to be taken to dispel the misconceptions about psychiatry.