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.

The aim of the study was to identify medical and socio-demographic characteristics of admissions considered inappropriate by psychiatrists. Appropriateness of admission was assessed by questionnaire. Medical and socio-demographic characteristics of each admission were obtained by case note review.

Twenty-five per cent of admissions were considered inappropriate. These patients showed high levels of adverse socio-demographic characteristics and commonly were diagnosed as personality disordered or as substance misusers. Junior doctors commonly admitted patients despite considering admission inappropriate.

Regular audit of the admission, process should be encouraged.

In this paper an experience of facilitating a weekly support group for nursing staff on an oncology ward is described. A brief overview of burnout among oncology nurses is followed by a description of the processes by which the support group was established.

Some of the functions that the group has come to provide and recurring themes are highlighted along with a more theoretical understanding of the nature of groups within institutions.

Support groups can help prevent isolation and demoralisation.

Following concerns over recruitment into general adult psychiatry, this study was undertaken to determine which factors influence senior trainees in psychiatry with regard to whether or not they choose a career in general adult psychiatry. The method used was by postal survey of all senior and specialist registrars in the UK.

Of those responding, 32.6% had chosen a career in general adult psychiatry, while 38.9% had actively rejected such a career. Twenty-six per cent of respondents had chosen another speciality without actively rejecting general adult psychiatry. For those actively rejecting general adult psychiatry, the top three factors cited were poor resources (57.6%), high workload (43.2%) and poor working conditions (30.7%).

Through an awareness of why senior trainees reject general adult psychiatry as a possible career, resources can be targeted more specifically in the future at the factors responsible, and thereby improve recruitment into this speciality.

We describe a new home treatment service established In one sector of the city of Bradford.

There was a tendency for the patients hospitalised from this sector to have more unstable housing backgrounds. It was found that a higher percentage of patients with diagnoses of serious mental Illness were cared for at home.

We argue that even in the presence of home treatment, there Is a continuing need for asylum. However, we make the case that this does not always have to be provided In a medical environment.

In an attempt to reduce patient non-attendance at first appointments, consultant referrals were handled differentially over three years. From referral letters some patients were referred elsewhere, some sent appointments and some invited to make appointments.

There was a reduction in patients who did not attend an appointment and an increase in the proportion of patients, not referred elsewhere who were seen.

This system reduces consultant waiting time in clinics and the interval before a patient is seen.

To describe physical sequelae of cylindrical battery ingestion and their management by description of recent cases and literature review.

X-rays should be performed to determine the position and integrity of the battery. In the absence of abdominal symptoms, immediate surgical opinion may not be indicated.

Conservative management of battery swallowing is frequently possible.

A postal questionnaire sent to all psychiatrists working in four NHS trusts in and around Birmingham was used to survey the number of new cases of drug and alcohol misuse identified in the previous month and the degree of postgraduate training in the management of such cases. Attitudes and beliefs about substance misuse problems were also elicited.

A response rate of 70% was achieved across six sub-specialities in psychiatry and four levels of training. Of the 143 respondents, over half had identified at least one new case of alcohol (61%) or drug misuse (55%) in the previous month. Approximately half of the sample admitted to having received no training in management of substance misuse cases in the previous five years (45% alcohol 50% drugs). There was general agreement about the potential management role of the doctor in the field, but less consensus on whether the clinician had a responsibility to intervene in such cases. A clear discrepancy was demonstrated between psychiatrists' perceptions of the evidence supporting various treatments and the actual evidence base.

The study highlights the pressing need for training psychiatrists at all levels and in all sub-specialities in the management of substance misuse.

To monitor the effect of the introduction of olanzapine under naturalistic conditions to patients with severe and enduring mental Illness in three rehabilitation services.

Thirty patients were prescribed olanzapine during the first six months of its launch. Objective ratings were used. Six months later, one-third were no longer on treatment one-third were unchanged and one-third had made useful clinical gains.

Patients who have suffered from neurological or prolactin-related side-effects may benefit from treatment with olanzapine. Attitudes to treatment and adherence may improve.

To audit the clinical practice of seizure threshold estimation and subsequent stimulus dose adjustment in the electroconvulsive therapy (ECT) clinic. Case notes of patients who had ECT over a six-month period were audited. Results were discussed at an audit meeting and guidelines and training modified appropriately prior to the second cycle of the audit.

Initial dose titration was poor in the first period, but improved in the second. The majority of patients were insufficiently stimulated after missed seizures in both periods and stimulus doses were not being reduced following prolonged seizures.

The audit identified the need for continuing supervision of trainees in addition to clear training and guidelines.

To set up a liaison psychiatry service for an obstetric department and review how much of the work involved in such a service can be undertaken by a senior registrar in two special interest sessions.

It was clear there was a demand for a service for women with psychiatric problems associated with childbirth. Referrals from colleagues in general psychiatry meant that the available time was soon used up. This did therefore not allow time to develop efficient systems for referral and management or to then see the extra referrals this would have produced. The limited and temporary service was well received by other professionals and by patients. The number of referrals received fell far short of the expected morbidity.

In an area with this number of births and its consequent level of psychiatric morbidity, it would not seem possible, within two special interest sessions, to develop a more formalised or comprehensive system.

The attitudes of members of the general population to people with psychiatric and physical illnesses were examined. We took a random sample of 280 members of the general population listed in the phone directory and sent them a brief clinical vignette about a neighbour with either schizophrenia, depression, diabetes or no illness.

Only 103 (41%) of the surveyed general population responded. Some unsolicited comments revealed negative attitudes from a small number of subjects. There were, however, no statistically significant differences in general attitudes to sufferers of psychiatric and physical illnesses suggestive of discrimination against the former. Indeed, respondents showed a general tendency to be more supportive of a neighbour with any illness than to those without. In a sub-analysis, however, those who knew someone with schizophrenia were significantly less likely to be sympathetic towards them.

We have not detected any general stigmatisation of those with psychiatric disorders, but our results may be attributable to response bias. Discrimination against those with psychiatric disorder may be limited to a relatively small sector of society or may only be manifest in relatively close relationships.

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.

To define serotonin syndrome and its symptoms and to discover which drugs or drug combinations are likely to cause it. A review of literature (including case reports) relating to serotonin syndrome collated from searches of MedLine and Micromedex covering the period January 1991 to July 1998.

Most of the data found were either individual case reports or reviews of case reports. Reports of serotonin syndrome seem to be growing, certainly since the introduction of selective serotonin reuptake inhibitors. Particular combinations seem most likely to induce serotonin syndrome. Awareness of this syndrome as a distinct clinical entity seems to be growing.

Serotonin syndrome is more likely to occur with drug combinations, especially those involving monoamine oxidase inhibitors. It can also occur when swapping antidepressant therapy, especially If changing from a long acting antidepressant such as fluoxetine. Caution is needed when changing antidepressants and particularly when they are used in combination.

To determine the attitudes of psychiatrists towards the practice of evidence-based medicine by use of a postal questionnaire. A survey was sent to Consultant Psychiatrists and to Higher Trainees in Psychiatry in the West of Scotland Region.

While older influences on decision-making such as tradition and deference still play a part, almost all respondents consider the adoption of more effective care based on best available external evidence desirable; most think it attainable. The technology is generally available, but further training is desired to access the information and its critical analysis.

Educational activities should increasingly focus on skills for data search and critical analysis.

Surveys of career intention among medical students, Membership Examination results and manpower figures are used to examine trends in recruitment to psychiatry over the last 10 years.

Problems of recruitment to psychiatry have increased. Consultant expansion contrasts with a fall in the number of medical students. The increase in the number of career senior house officers and specialist registrars is insufficient to fill existing consultant vacancies notwithstanding new and replacement posts. The popularity of general psychiatry and psychotherapy have declined.

Proposals include an increase in the number of medical students, the introduction of psychiatry in the pre-registration year, increased specialisation and closer integration of general adult psychiatry with general medicine.

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.