To survey some aspects of care relevant to good practice in psychiatric intensive-care units.

A number of areas of concern were identified, including care issues for informal and female patients, a lack of uniform clinical leadership and a paucity of policies/guidelines for high-risk areas of clinical practice.

In an attempt to provide a service for the most disturbed patients from widely varying sources, psychiatric intensive-care units are at risk of compromising the ability to provide good-quality clinical care.

From March 1997, the acute day hospital in Central Manchester was extended to 24 hours, seven days a week, with patients treated entirely at home if preferred. The development and organisation of the new service are described. Preliminary evaluation data include service activity for the first 12 months and comparison with a consecutive series of in-patients during the first three months.

There was an increase in the number of patients treated in the first year (n=214). Sixty-two per cent of patients suffered from schizophrenia, psychotic depression or bipolar disorder. Patients treated by the new service in the first three months (n=43) were more likely than in-patients (n=37) to have problems eating or drinking and to present with suicide risk, whereas the inpatients were more likely to have had adverse past experiences of services and to show behavioural disturbances.

The findings support the continued development of 24–hour alternatives to inpatient care, while emphasising that those requiring inpatient care have different presentations and needs.

To describe the characteristics of probationers assessed (n=83) and supported (n=31) by a mental health worker (MHW) attached to a probation service. A survey of cases and case descriptions.

Referrals were predominantly White, unemployed males on probation orders. Most had acquisitive/property and violent convictions along with substance misuse problems and personality disorder diagnoses. The MHW supported probationers already in contact with psychiatric services and provided a safety net and sometimes sole support, to those who were not.

The MHW helped to bridge the gap between criminal justice and mental health systems by facilitating contact between probationers and psychiatric services. The clinical effectiveness of the scheme should now be examined.

We surveyed the prescription of neuroleptic drugs in patients with a diagnosis of dementia discharged from a general psychiatric hospital over two consecutive years. The surveys looked at documentation of information around prescribing and communication to primary care teams. Our aim was to help to minimise the potential contribution of hospital practice to unnecessary or continuing unreviewed neuroleptic prescription in the community.

The first survey led to the adoption of new clinical standards in the Department of Old Age Psychiatry. The second survey found improvements in all surveyed parameters.

Clear communication of information around prescribing and follow-up arrangements could help to reduce inappropriate community prescription of neuroleptics in this vulnerable group of patients.

This audit examines the quality of ‘as required’ (p.r.n.) prescribing for in-patients before and after standard setting.

There were improvements in writing oral/intramuscular prescriptions and in the use of different drugs regularly and p.r.n. There was a trend for improvement in completion of guidelines for those on high doses but completion was not influenced by hidden p.r.n. prescribing. Writing p.r.n. prescriptions as a ranged dose was common and did not improve significantly.

By using some simple measures, improvements in some aspects of potentially problematic p.r.n. medication can be achieved.

The aim of this study was to examine the pattern and basis of use of psychotropic drug prescriptions by psychiatrists to relieve anxiety symptoms arising from non-psychotic disorders. A questionnaire survey was conducted among senior psychiatrists in the Wessex region.

The response rate was 74%. A range of psychotropic drugs was used to treat non-psychotic anxiety symptoms, most commonly selective serotonin re-uptake inhibitors, tricyclic antidepressants and antipsychotic drugs. Antipsychotic drugs are reserved for second- and third-line treatments, mainly in low doses but sometimes in high doses and for long periods. The use of antipsychotic drugs as anxiolytics was seen by the majority of responders as reasonable practice, and they are considered suitable alternatives to benzodiazepines. This practice was based mainly on personal experience.

Anxiety symptoms arising from non-psychotic disorders are common in the out-patient population. Although antipsychotics are used by psychiatrists to relieve these symptoms, the ‘evidence base’ for such practice is flimsy and mainly based on clinical experience. The benefit/risk ratio should be considered carefully before prescribing antipsychotics for non-psychotic anxiety. Further research is needed in this area, contributing towards general guidelines.

A re-audit of the current practice of electroconvulsive therapy (ECT) was carried out over a period of five months using the new guidelines produced by the Royal College of Psychiatrists. The areas audited included obtaining consent from the patients, information recording, training and supervision of the junior doctors and the practical aspects of ECT administration, including dose titration.

An improvement in the training and supervision of junior doctors was seen since the last audit but shortcomings were identified in areas of pre- and post-ECT preparation, information recording and correct use of stimulus-dosing policy.

Recommendations include the need to improve clinical practice and recording of information.

A tertiary assessment package was set up for the more equivocal cases of attention-deficit hyperactivity disorder (ADHD) who present with problems of inattention, impulsivity and overactivity. The structure of the three-day package was discussed, with an analysis of our experience in assessing 12 children using the pilot project. The package and Its use in clinical practice are presented.

The pilot project described can be modified into a two-day package.

Assessment of ADHD conducted in multiple settings inherently has many advantages over single clinic assessment. We suggest that such an assessment protocol can be conducted cost effectively.

To investigate the impact of a video to improve the accuracy of patients' expectations of their first out-patient appointment. An intervention study was conducted in which patients watched a video before their appointment. The video provided information about the content of the consultation, the psychiatrist's role and types of treatments.

The intervention increased the accuracy of patients' expectations but had no impact on satisfaction or anxiety. The video was popular as a means of preparing patients for the consultation.

This could be offered routinely to patients attending services for the first time.