Driving during and after a psychiatric illness is an important area about which relatively little has been written. This paper reports on a questionnaire study aimed at seeking psychiatrists' knowledge and views on this issue. Of 187 questionnaires distributed 101 were returned, and replies indicated that psychiatrists are generally unaware of regulations currently in force. Suggestions on how to improve matters are mode.

A cross-sectional survey of all in-patients at a psychiatric hospital was performed to see to what extent College guidelines on neuroleptic prescribing were being adhered to. Thirteen (7.3%) patients were found to be on high doses and one (0.6%) on megadoses. Only 23% in the high-dose group had had an ECG at all, and Just 7.7% had had one in the previous three months. The single patient on megadose treatment had had an ECG but not In the previous three months. Prescribing habits that could potentially have led to 21.9% of patients receiving high doses and 9.0% megadoses were identified, and reasons for the low rate of ECGs discussed.

The circumstances associated with high lithium concentrations detected by 23 district laboratories in the West Midlands during a 22 month period were investigated.

The quality of lithium monitoring in a health district serving a population of 450 000 was studied over a period of a year. The following instances of poor monitoring were found: too frequent monitoring in stabilised patients, and failure to take action when lithium values fell below 0.3 mmol/l or rose above 1.0 mmol/l. Ways of improving the standard of monitoring are considered.

A review of the drug treatment of 163 patients attending two old age psychiatric day hospitals showed that 29 received medication from the day hospital, 44 from general practitioners and 60 from both sources. Many of the patients' knowledge of their drug treatment was incomplete. Of those individuals interviewed, approximately equal numbers expressed a preference for day hospital and general practitioner prescriptions. The origin of the prescription did not bear any obvious relationship to subsequent admission to hospital or continued attendance at the day hospital.

Increasing involvement of users in health service planning has led to a movement towards patients having more information about their care. Some have advocated patients having access to their medical records and this is now a statutory right. There has been concern as to whether this is suitable in mental health. An addition or alternative to access to medical notes is a client held record which might increase the patient's feeling of autonomy while also improving communication and compliance. In studies on access most patients and staff have found this beneficial. Client held records have also been positively received in the few studies reported but more evaluation in routine practice Is needed.

Previous studies have looked of repeated admissions and failed discharges but none have followed up a group of patients requiring multiple admissions over several years. We found that of the 42 patients admitted three or more times to acute wards in 1990, half were having a bad year and did not require this level of inpatient care in succeeding years; one-quarter continued to use acute services heavily but none required three or more admissions in every year of follow-up; one-quarter did badly and required prolonged in-patient care or died.

The effects of establishing a full multidisciplinary community psychiatric team in central London are described. The nature of referrals, and referrers' satisfaction with the service were examined during two comparable six-month periods, before and after the changes. The number and severity of referrals increased, and referrers were more satisfied with the new service. In contrast to the inter-agency model, the new multidisciplinary team was associated with more appropriate referral of those patients with the greatest need for specialist services. Clinical skill mix in the team and referrer education are the two factors most likely to have promoted these important changes. The key role of the psychiatrist in a full multidisciplinary team who can empower multi-professional case managers in their day-to-day management of severely ill patients is highlighted.

This text discusses whether senior trainees should endeavour to Join a College Approval Panel as one of the visiting team, what the advantages would be to the trainees being visited of having a senior trainee representative as a member of the assessing group and what the benefits are to senior trainees in terms of training and broadening their own curriculum vitae.

We performed a survey to examine the behavioural–cognitive psychotherapy teaching and experience of trainee psychiatrists in the South Thames (West) Region. Sixty-four per cent of the whole sample who responded to the survey, including 90% of the registrars who responded, had treated at least one patient using behavioural cognitive methods. Few trainees reported no experience of behavioural cognitive psychotherapy with almost all attending some form of teaching. Trainees generally reported that they valued this experience.

The common thyroid disorders are all autoimmune in origin, with the lifetime risk of thyroid disease being 1–2%. Thyroid autoantibodies are present in 9% of the adult population and 12.7% of women, with the frequency rising steeply in women over 45 years of age (Myers & West, 1987). In addition, 20% of the over 60–year-olds have an abnormal (raised) thyroid stimulating hormone (TSH). The presence of both raised TSH and thyroid autoantibodies is associated with the development of clinical hypothyroidism at the rate of 5% per year (Myers & West, 1987).

Although baseline blood tests are routinely checked on hospital admission when patients may be medication-free, it is frequently forgotten that psychotropic drugs can cause a wide range of abnormalities in such tests, some common and some very rare. These abnormalities, and the monitoring requirements associated with them are summarised in Table 1.

Although haloperidol (HAL) has been available as an antipsychotic for over 30 years, controversy still surrounds the appropriate dose in the treatment of psychosis and in particular, schizophrenia. In practice, high dose HAL (greater than 20 mg/day) continues to be prescribed, despite good reason for not doing so: the incidence of extrapyramidal side-effects (EPSE) is known to be dose-related; and compliance with treatment may be adversely affected by side-effects, especially akathisia and Parkinsonism.

Many sources of evidence inform clinical practice, including research findings, patients' views, and clinical experience. This article describes recent progress in developing what will be the College's first guideline, The Assessment and Management of Violence In Clinical Settings. The design of the programme acknowledges the diversity of evidence in this area, by drawing a distinction between different types of evidence. Evidence is systematically identified and its quality appraised by the Work Group, through commissioning literature reviews. Initial recommendations will be based on experimental data. The methods used to consider non-experimental data, particularly expert opinion, will be described in more detail in a later article in this series.

Reports of deliberate self-harm (DSH) are rare from Pakistan where psychotropic drugs can be obtained ‘over the counter’. A retrospective analysis of 302 index cases presenting to a university hospital in Karachi showed self-poisoning with benzodiazepines as the most common method, followed by organophosphate insecticides. Salicylates and non-opiate analgesics were significantly absent from our series. Implications of these findings are discussed.