To describe the implementation of a plan to use a validated outcome measure in the care and treatment of people with severe mental illness within a district general hospital psychiatric service. Multiple techniques were necessary to promote actual change of practice.

A survey of practice found 77% of full Care Programme Approach patients to have recorded Health of the Nation Outcome Scales (HoNOS) scores in their care plans one year after the beginning of the implementation plan.

It is possible to incorporate the use of HoNOS in to everyday practice but it takes a lot of time, effort and resources. Mental health services may require a clearer indication from the NHS Executive regarding the use of such outcome scales before committing themselves.

The aim of the study was to survey strategies for dealing with patients who refuse clozapine blood tests or tablets. One hundred and twenty-five psychiatric intensive care unit consultants were sent a questionnaire.

Thirty-nine (31%) questionnaires were returned. Opinions and practices were diverse ranging from uncertainty around the legal right to enforce venepuncture, to the practice of slipping clozapine into a patient's drink without their knowledge.

There is need for an open debate of the relevant legal and ethical issues.

A questionnaire was sent to members of the Psychotherapy Section of the Irish Division of the Royal College of Psychiatrists to assess psychotherapy training.

Members from Northern Ireland, compared with those from the Republic, had more mandatory psychotherapy experience in a variety of psychotherapies, had attended more lectures on the theories of the psychotherapies, had cases longer in analysis and were more satisfied with their level of supervision. Few non-consultant hospital doctors had obtained mandatory psychotherapy training as outlined by the College guidelines and they were also generally dissatisfied with their basic training in psychotherapy.

Although there were clear qualitative differences in psychotherapy training between Northern Ireland and the Republic, 100% of members believed there should be improvements in the training of psychotherapy in Ireland. If the Royal College guidelines are to be adhered to, these results would imply that changes in the structure of psychotherapy training in Ireland particularly for non-consultant hospital doctors are required.

The study was undertaken to examine over the counter drug sales from hospital shops. One hundred hospital shops were sent a questionnaire asking for details of drugs sold and any policy to prevent sales to patients.

Seventy-three shops replied, 20 of which sold medication. Most had policies which would allow sales to patients. Three shops had sold medication which was subsequently used for self-poisoning by in-patients.

Hospital managers and clinicians should ensure hospital shops have effective policies to prevent medication sales to patients.

The aim of the paper is to describe the pre-registration house officer training in psychiatry available in Sheffield. The report is the result of a postal questionnaire, involving all of those who undertook pre-registration house officer training in psychiatry, since the inception of this option.

The results suggest that the psychiatry option as part of pre-registration house officer training was regarded as useful by almost all undertaking this training. Some of the suggestions to improve the experience are already incorporated into the current posts.

The findings support the development of further posts of this type, and such developments may assist in overcoming some of the difficulties in recruitment into psychiatry as a career.

To examine the onset and course of clinically observable improvement in patients receiving electroconvulsive therapy (ECT). A prospective design was used In which 19 consecutive patients receiving ECT were followed up from commencement to termination of ECT. The Clinical Global Improvement Scale was administered at every ECT session to monitor their Improvement.

Eleven of the 19 subjects Improved minimally and another subject Improved substantially after the first two ECT treatments.

ECT produces clinically observable improvement in depression within a few days of starting treatment perhaps earlier than is generally acknowledged.

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 survey of recorded refusal of drug administration to patients in a psychiatric hospital over a six-month period in 1996 was made using drug administration records. For comparison 150 patients were randomly selected from the 1975 drug sheets and instances of drug refusal noted.

Eighteen per cent of patients refused drugs on at least one occasion, and of those over 65 years of age 26.2% refused drugs. All the main diagnostic categories and groups of drugs were involved. of the 150 patients studied from 1975 only four refused drugs.

Doctors should be alert to the possibility of refusal of drug treatment in a wide range of psychiatric conditions. When refusal occurs interventions are likely to be necessary, including a review of drug treatment.

This paper describes and evaluates a new community treatment service for women suffering from mental Illness during the perinatal period. Data about referrals, treatment methods and outcome were analysed for the first year of Its service.

The service was acceptable to patients and effective in improving the mental health and parenting skills of mothers but less successful in improving relationship problems.

A specialised perinatal outreach service is likely to be more acceptable to new mothers than the traditional psychiatric service and may also be able to reduce the need for hospital admission and length of admission.

This paper describes the characteristics and outcome of the first 20 patients seen by a newly appointed specialist registrar in cognitive therapy. The outcome of the first (cases 1–10) and second (cases 11–20) cohorts were evaluated to assess if training had any impact on clinical effectiveness.

Comorbidity was common, but more patients improved following the intervention (effect size=0.64–1.34). The 25% therapy drop-out rate was comparable with previously reported rates. Four out of five patients who dropped out had Cluster B personality disorders. The two cohorts showed similar baseline characteristics, but the second cohort showed improved outcome (effect size of training=0.89–1.04) and had a significantly shorter course of therapy (P=0.02).

Specialist registrar training in cognitive therapy provides experience in treating a wide variety of mental disorders. The routine collection and analysis of clinical and psychometric data helps identify training effectiveness and training needs. The data demonstrate that training was associated with improved patient outcomes.

To explore clozapine and atypical antipsychotic usage in England and Wales, particularly availability, restrictions on use and shifting of prescribing to general practitioners. To examine the hypothesis that respondents in acute trusts would encounter more restrictions. Method used – postal questionnaire sent to general psychiatrists derived from the 1996 Medical Directory.

There was an 80% response rate and over 90% of respondents used clozapine, with only 9% reporting any difficulty in obtaining it. Difficulty was not associated with any particular type of trust. Only about 4% of respondents suggested that general practitioners regularly took over the prescribing costs of the drug.

Optimistic, with widespread usage and few difficulties in obtaining clozapine. General practitioner prescribing is still very low and needs to increase.

To describe one of the first psychiatric services in the inner-city especially designated for female psychiatric patients with severe mental illness.

The referral system, the staffing levels and the admission criteria have been established following needs of the patients, especially young women with perinatal problems and women from ethnic minorities.

This single gender acute psychiatric ward has received welcome attention from mental health professionals and management at every level, and it is hoped that further discussion will help to clarify future policies and guidelines on all aspects of this venture.

The prevalence of errors in reference citations and use in the psychiatric literature has not been reported as it has in other scientific literature. Fifty references randomly selected from each of three psychiatric journals were examined for accuracy and appropriateness of use by validating them against the original sources.

A high prevalence of errors was found, the most common being minor errors in the accuracy of citations. Major citation errors, delayed access to two original articles and three could not be traced. Eight of the references had major errors with the appropriateness of use of their quotations.

Errors in accuracy of references impair the processes of research and evidence-based medicine, quotation errors could mislead clinicians into making wrong treatment decisions.

Retrospective information on advice and information received post-diagnosis was obtained from 40 carers of younger people with dementia, using a semi-structured interview.

Twelve carers received services from old age psychiatry, the remaining 28 from predominantly adult psychiatry or neurology. Those in receipt of old age services reported greater adequacy of diagnostic information, higher levels of advice giving and more frequent referral to social services.

While old age services were more successful on the parameters examined, the gradually emergent nature of the diagnosis may be a crucial factor in the lack of information and advice received by the comparison group.

To assess the extent of user involvement in care planning, from the users' perspective. Fifty Care Programme Approach (CPA) meetings across five consultant teams were included using quota sampling. Data concerning user involvement was collected by direct observation, semi-structured interviews with users and keyworkers and a review of CPA documentation.

User involvement in needs assessment and decision-making was poor, as was knowledge of care planning and information provision to users.

Limited resources and conflict resulting from the more containing aspects of the CPA remain obstacles for user involvement. Possible improvements include user led needs assessment, information pack provision and limiting attendance at CPA meetings.

The aim of the study was to investigate changes in child care arrangements after admission of mothers to acute psychiatric wards. Data were collected by interview where possible and from case notes.

Twelve out of 63 children of mothers interviewed had to move house. Chronicity of psychiatric disorder was evident in half the mothers.

Children's lives are affected by maternal psychiatric admission with the likelihood of repeated disruption where psychiatric disorder is chronic.