A postal and telephone survey of 140 community drug teams was undertaken to determine geographical variations in waiting times and methadone prescribing policies.

The average waiting time was 7.2 weeks for assessment and 10.6 weeks from referral to receiving methadone. ‘Methadone maintenance’ was not available in 25 units, although it was commonly provided in 41 units. In-patient detoxification for illicit drug dependence was available in 108 units, of which 59 units had access to beds in dedicated drug-dependency units, while the remaining 49 units referred in-patients to general psychiatry wards.

Despite government guidelines, it was clear that methadone was readily available to opiate users in some units whereas prescribing was very limited in others. The great variation in prescribing policies and waiting lists between community drug teams will make it extremely difficult to compare their effectiveness. Waiting lists are an explicit target for the National Treatment Agency involved in commissioning substance misuse services.

To assess the impact of a clinical risk assessment and management policy introduced in a tertiary rehabilitation service, in response to UK government statute. The study assessed the effect of a formal risk management approach for high-risk cases over a year, in terms of changes in risk-associated behaviour and perceived levels of risk, and in achievement of clinical risk management goals.

Initially 35 of 107 patients were rated as high risk, mostly of neglect or of harm to others, and were subjected to formal risk management. At follow-up only 16 patients were still rated as high risk, most reduction occurring in risk of neglect. Half of the 112 risk management goals established were fully achieved, 58 partially and 18 not achieved. Total Social Behaviour Schedule ratings were significantly lower at follow-up.

Risk management appeared to be successful in terms of reducing overall levels of risk, the achievement of risk management goals and the reduction of risk-associated behaviours. The lack of a control group and blindness limits the validity of these findings. However, organised risk management procedures may help to support and promote good general clinical management.

To describe Brunswick House, the first crisis house in North Staffordshire, and to assess the use of acute psychiatric wards and the local accident and emergency department by Brunswick House residents. A mirror design study compared the use of these facilities in the year before with the year after a resident's first admission to Brunswick House.

Data collected on a cohort of Brunswick House residents between March 1999 and December 1999 showed a reduction in both the use of acute psychiatric wards and use of the accident and emergency department after the index admission to Brunswick House.

Brunswick House provides an alternative to NHS facilities for people in crisis.

To compare methohexitone and propofol in electroconvulsive therapy (ECT). A retrospective within-subject comparison was made of the use of these drugs in separate courses of bilateral ECT in one clinic over 10 years. Patients taking mood stabilising or anti-epileptic drugs were excluded. The initial seizure threshold and seizure duration were of particular interest.

The median initial seizure thresholds were identical (75 mC). The median initial seizure duration with threshold stimulation was 25% shorter with propofol (21v.28 s). The median total numbers of treatments in the courses were identical (eight treatments).

The shorter seizure duration observed with propofol was not associated with a commensurate rise in the initial seizure threshold. The shorter seizure duration may therefore have no effect on the therapeutic efficacy of treatment.

To describe and attempt to quantify the incidence of disinhibitory reactions to benzodiazepines and to identify those at risk. Medline search, 1966–January 2002.

The overall incidence of disinhibitory reactions is small, but those with impulse control problems, neurological disorders, learning disabilities, the under 18s and the over 65s are at significant risk.

It is important to be aware of the ability of benzodiazepines to cause behavioural disinhibition and to maintain a high degree of vigilance when these drugs are administered to patients known to be at risk. In patients who have experienced behavioural disinhibition with benzodiazepines, antipsychotic drugs should be used to modify behaviour in any future emergencies.