We surveyed the views and experiences of all mental health professionals in adult community mental health teams and approved mental health professionals in 2Gether and Oxford Health NHS Foundation Trusts, regarding the use of community treatment orders (CTOs).

A total of 288 surveys were completed (response rate 48%). Forty-eight (83%) psychiatrists and 142 (67%) non-psychiatrist mental health professionals were in favour of CTOs. The decision-making regarding CTOs was overwhelmingly clinically oriented for all professional groups. However, there were significant differences in views between groups regarding the effects of bureaucracy, the infringement of human rights and coercion.

Multidisciplinary team involvement is crucial in decisions regarding CTOs and may protect against idiosyncratic or unhelpful practice. Further training for staff is urgently required and there may be a case for creating small local reference groups that can develop expertise and provide advice and support for clinical teams.

This article examines mental health disorders as individuals transition from adolescence to adulthood. Data were collected from clinical records of patients who had transitioned from child and adolescent mental health services to adult mental health services in a region in South Wales. Demographics and clinical diagnoses under both services were recorded. Patterns between adolescent and adult disorders as well as comorbidities were investigated using Pearson's χ2-test and Fisher's exact test.

Of the 98 patients that transitioned from one service to the other, 74 had changes to their diagnoses. There were 164 total changes to diagnoses, with patients no longer meeting diagnostic criteria for 64 disorders and 100 new disorders being diagnosed. Comorbidity increased in adulthood.

Diagnoses can evolve, particularly during adolescence and early adulthood. Therefore regular reassessment is paramount for successful treatment.

None.

High rates of metabolic syndrome exist among patients on clozapine. Monitoring its parameters facilitates interventions which may alleviate negative health consequences. We completed an audit of the monitoring of the parameters of metabolic syndrome in patients on clozapine. The results were compared with the Maudsley Guidelines for monitoring in patients on any antipsychotic medication.

Initial audit showed high overall rates of concordance with guidelines for the frequency of measurement of blood pressure (91.8%), but much lower rates for measuring fasting blood glucose (43.2%) and lipid profile (52.7%), and no record of analysis of waist circumference. This prompted development of a formal protocol for measuring parameters. Repeat audit after 1 year showed marked improvement in rates of measurement.

Implementation of relatively straightforward measures, such as the introduction of a one-page form on which to record parameters, can lead to a much improved rate of monitoring for metabolic syndrome. This should in turn prompt therapeutic interventions, which are discussed.

The study aimed to determine whether medical students who participated in a student psychotherapy scheme aimed at helping them learn about the doctor-patient relationship were more likely to choose psychiatry as a career than a control group who did not participate. One hundred and ninety-eight medical students who participated in the University College and Middlesex School of Medicine (UCMSM) Psychotherapy Scheme between 1982 and 1992, and 200 randomly selected students of the same period who did not, were sent a questionnaire asking about career choice.

Seventy-seven of 163 participants in the scheme who sent back the questionnaire had not thought about doing psychiatry before entering the scheme. Of these, 11 became psychiatrists (14.3%), compared with only two (1.6%) of the 128 controls (of 152 respondents) who had not considered psychiatry as a career at the same stage. This difference is highly significant (P<0.001). Many of the participants, including those who did not specialise in psychiatry, emphasised how the scheme had helped them understand the doctor-patient relationship.

Participating in the Student Psychotherapy Scheme encouraged medical students to choose psychiatry as a career. This knowledge is important, particularly in view of the current recruitment crisis in psychiatry.

To evaluate ultra-rapid opiate detoxification under sedation. Symptom control was analysed in the first 12 hours of detoxification in 20 patients and case notes were examined 12 weeks later for outcome.

Good symptom control was achieved, except for restlessness. At 12 weeks 25% patients were abstinent.

While long-term outcome is similar to conventional methadone detoxification, the ultra-rapid technique is safe, more acceptable to patients and more cost-effective.

A repetition after 5 years of a prospective case note audit, looking at the impact of a recently established deliberate self-harm (DSH) assessment team on the quality of DSH assessments at Kettering general hospital.

Aspecialist DSH team achieved improvement in the quality of psychiatric assessments for the majority of patients who harmed themselves. Assessments of mental state by accident and emergency (A & E) and medical staff before referral to the psychiatric team remain problematic.

Setting up aspecialist team to assess patients who harm themselves can improve the quality of the psychiatric care they receive, but emphasis must still be placed on an adequate assessment of mental state by medical and nursing staff in A&E and on medical wards.

Religion and spirituality are very important personal aspects of many people's lives. Little work has looked at the beliefs of mental health professionals and how they reconcile or benefit from the potential differences of religious faith and evidence-based mental health practice. This study used semi-structured interviews to qualitatively explore how professionals from different occupations and faiths conceptualise the relationship between their beliefs and their work.

The commonly cited ‘conflict’ of science and religion was noted, as was the personal support that faith provides for many people. Participants felt their beliefs made them better at their job, not only by reconciling differences from the two paradigms but also by allowing them to recognise compatible attributes of seeking meaning to subjective experience; this had positively influenced their choice of career in mental health. A desire for ongoing opportunity to express and discuss this interface was strongly expressed, but with concern about how this would occur and be perceived.

There is a lack of qualitative research on the religious beliefs of mental health staff. In the UK generally, the role of faith in public life is a strongly debated topic in the context of an increasingly secular and yet multicultural and multi-faith society. Our data suggest that professionals' beliefs positively influence their choice of career in mental health and make them feel better equipped to undertake their roles and provide good-quality patient care. There is an expressed need for further opportunities for staff to discuss their beliefs – or lack thereof – and to consider the individual impact of beliefs on their professional life.

Most medical diagnoses are made from the physical history alone. In the psychiatric literature, physical assessment usually focuses on examination rather than history. We aimed to ascertain the relative importance that trainee psychiatrists attach to the physical history and examination, and to investigate their actual method of physical assessment. The relative weight that trainees attach to physical history and examination was assessed with a postal questionnaire. Their actual practice was evaluated by reviewing a selection of case notes from patients under their care.

Trainees weighted the physical examination as more important than the history in theoretical terms (P=0.02). They also indicated that they attached more importance to examination in their own practice (P=0.03). On review of the case notes, 34 (71%) of inpatients had been physically examined, but only one (2%) had evidence of a physical history.

It appears that many psychiatric trainees do not adhere to the basic medical principle of taking a physical history on which to base a physical examination. ‘Blind’ examinations are unlikely to yield medical diagnoses. These findings have implications for our patients' health and psychiatric training.