To determine the rates at which clinical teams within one NHS trust placed older people on a Care Programme Approach (CPA) register and to examine the degree to which clinicians' use of the register conformed to trust policy. Two retrospective case notes surveys were carried out 6 months apart within a completed audit cycle.

Consultant teams varied considerably in their application of the CPA policy. Feedback to clinicians after the first survey had a variety of effects on subsequent use of the CPA register.

Health service policies exist to reduce variation in clinical practice and to ensure minimum standards. Clinical audit may be a useful tool in identifying irrational variation within the framework of clinical governance.

Following the introduction of donepezil into clinical practice a protocol for prescribing it was developed in Leicestershire. A prospective clinical audit was undertaken to monitor compliance with the protocol, which also provided an opportunity to evaluate the outcome of therapy in routine clinical practice.

Overall there was close adherence to the protocol by the clinicians and clinical factors, as well as organisational and resource-related factors, were important in determining who received treatment. The principal outcome measures (Mini-Mental State Examination, Barthel ADL Index and Clinical Dementia Rating Scale) did not demonstrate any significant treatment effect.

This study demonstrates the feasibility and acceptability of using a protocol-based approach to manage the introduction of new drug treatments in psychiatry.

Dementia and depression are common psychiatric diagnoses in older people, and are common reasons for referral to liaison psychiatry services. The present study examined the accuracy of physicians' diagnoses for both disorders in consecutive referrals to a liaison old age psychiatry service.

Positive predictive values for depression and dementia were high, but levels of treatment of depression and documentation of past psychiatric history were both poor. Alcohol misuse and stroke accounted for the commonest accompanying disorders.

The findings have implications for the encouragement of physicians to treat depression when this is suspected. Educational programmes for this purpose may be useful, incorporating an exploration of attitudes and knowledge of physicians towards depression in older people.

Neuroleptic medication is often used in excess of the BNF maximum. The purpose of this study was to examine the relationship of neuroleptic dose to patient, prescriber and environmental factors, by using a cross sectional ‘snapshot’ study of psychiatric in-patient prescriptions combined with a retrospective case note survey.

It was found that certain consultants prescribe higher doses of neuroleptics than others. Patients with a history of aggression had a nine and a half times higher chance of being prescribed higher doses of neuroleptics. Patients with a greater than 5-year history of neuroleptic prescription received higher doses.

High neuroleptic prescription is related more to patients' past reputation and prescriber differences than to patients' current behaviour.

Objective and subjective lithium compliance was investigated in 30 out-patients attending at an affective disorders clinic. Possible precursors of compliance levels were investigated; namely lithium knowledge and attitudes, patient satisfaction and dosage of lithium administered.

All patients were defined as currently compliant. Patients with a previous history of non-compliance were exclusively diagnosed with manic depression. Patient satisfaction, lithium knowledge and attitudes were not good predictors of lithium compliance.

Compliance with lithium can remain excellent in the presence of moderate lithium knowledge and poor attitudes. Poor attitude towards lithium worsens with years on medication, despite high levels of compliance. Clinicians should be aware that larger prescribed dosages of lithium may be associated with poorer compliance.

To determine whether the College guidelines in liaison psychiatry are being implemented, a survey of training opportunities at senior house officer (SHO) level was undertaken. A detailed postal survey was conducted in January 2000. Information was collected about the number and nature of SHO liaison psychiatry posts from a wide range of sources.

Nationally, 45.5 SHO posts in liaison psychiatry were identified. These were unevenly distributed, with a high number in London. Only five posts were available to general practitioner trainees. Nine regions anticipated an increase in training opportunities. Regional liaison representatives had incomplete knowledge of the availability of liaison training opportunities in their region.

The College guidelines to incorporate liaison experience into all training schemes have not been implemented. In four regions no training opportunities were identified whatsoever. A national database is needed to monitor training opportunities and inform further development of training posts.