Little is known about the outcome of cosmetic surgery in patients with body dysmorphic disorder (BDD). Self-reported outcome was collected on 25 patients with BDD who at the time of psychiatric assessment had reported that they had had cosmetic surgery in the past.

Twenty-five patients with BDD had a total of 46 procedures. The worst outcome was found in those who had had rhinoplasty and those with repeated operations. Mammoplasty and pinnaplasty was associated with higher degrees of satisfaction. Nine patients with BDD, either in desperation at being turned down for cosmetic surgery or because they could not afford it, had performed their own ‘DIY’ surgery in which they attempted by their own hand to alter their appearance dramatically.

Cosmetic surgery cannot at present be recommended for patients with BDD. However, patients turned down for surgery or who cannot afford it, may try to alter their appearance by themselves. The study contains a selection bias of patients in favour of treatment failures in cosmetic surgery and prospective studies are required on BDD patients who obtain cosmetic surgery or dermatological treatment.

This paper describes a 10-year alliance between an adult psychotherapy service and a child and adolescent mental health service to bring psychotherapeutically-informed help to families in difficulties early in the lives of their children.

It outlines staff training, the development of the unit into a significant training resource, the unit's underlying philosophy, its therapies and the key inter-relationships between teams and with health visitors to enable mutual teaming and the rapid access of families to assessment and treatment of the parent-child relationship.

Funding, future plans and the preventive and economic implications of such work are mentioned.

To describe Drayton Park, the first women-only residential mental health crisis facility in the UK and to investigate whether it is succeeding in its remit of providing a viable alternative to hospital admission. We randomly selected case files from 100 women admitted to Drayton Park since its opening and examined variables including demographic details, the reasons for referral, diagnosis and the source of referral.

Our findings show that the service is able to respond quickly to referrals and appears to be functioning safely. The women admitted have a relatively short length of stay, half suffer from depressive episodes and one-third have a relapse of schizophrenia or bipolar disorder.

This project appears to be succeeding in providing a safe alternative to hospital admission for women with severe and enduring mental health problems.

Psychiatric emergencies constitute a large proportion of psychiatric referrals, with the response to this need therefore of great importance. The impact of the introduction of a telephone triage system on such factors as speed of response, assessment site, outcome and the personnel performing the assessment is examined within the context of closing of a 24-hour open access emergency system. Information was gathered from all emergency referrals, with 80 subjects randomly chosen and studied in depth.

The triage system afforded a greater flexibility of response, and the involvement of more experienced clinicians. It did not reduce the overall referral or admission rates.

Triage was found to be an effective method of introducing flexibility of response to emergency referrals while encouraging continuity of patient care.

To discuss the service offered by an in-patient neuropsychiatric brain injury rehabilitation unit. To examine the demographic details of patients admitted to the unit. To find the commonest reasons for referral.

The notes of 78 patients admitted to the unit, over a two-year period, were examined. Seventy-three per cent were male and the mean age was 45 years. Seventy-five per cent of admissions had a severe brain injury. Two-thirds of the patients were admitted within six months of their injury. The most common reasons for referral were memory difficulties (n=61), verbal aggression (n=31) and temper control(n=25).

In-patient neuropsychiatric brain injury rehabilitation units offer management of patients referred with a wide range of cognitive, behavioural, functional and physical problems.

A retrospective case note study provided data on the service consumption and outcome of treatment for a cohort of adult anorexia nervosa sufferers treated in a specialised secondary service.

A cohort of 106 patients was studied. Only just over a quarter were ever admitted. Of a subset of 78 patients, first seen before 1994, nearly one-fifth failed to engage in treatment. Those who were admitted spent on average a total of 10 months in hospital, were in touch for four years and had over 100 therapy sessions. The majority who were treated solely as out-patients remained in touch with the service on average for over two years.

Services for anorexia nervosa sufferers need to plan for prolonged contact with their patients and high rates of service consumption.

We aimed to examine variations in clozapine prescribing in all 12 NHS trusts with catchment area mental health services in one English county, over a 2-year period. We tested a series of hypotheses to explain the variation in prescribing of clozapine.

A 34-fold variation between trusts in rates of clozapine provision was found after adjusting for measures of local population need. This variation did not change over the 2 years examined. It was not explained by differences in resource level.

The evidence base is strong for the effectiveness and likely cost-effectiveness of clozapine in severe schizophrenia. Our data indicate that variations in evidence-based clinical practice at the provider level led to the wide variation in clozapine prescribing.

To compare how newspapers cover psychiatric and physical illness. We conducted a survey of relevant headlines in nine daily newspapers over a one-month period and judged whether the content was essentially positive, neutral or negative.

Over the one-month period, 213 article headlines about various aspects of medicine and 47 on psychiatry were identified. Ninety-nine (46%) of the former were critical intone as compared with 30 (64%) of the latter (odds ratio=4.42, 95% CI 1.64–11.94).We gained the impression that negative articles about physical medicine tended to criticise doctors whereas negative articles about psychiatry tended to criticise patients. Tabloid and broadsheet newspapers did not differ in their rates of negative coverage.

Psychiatry, psychiatrists and particularly psychiatric patients tend to be represented negatively in the newspapers. Psychiatrists should strive to influence the news agenda by proactively reporting positive messages, such as treatment advances.

We hypothesised that the increased admission rate for men with major mental illness may bethe result of men being preferentiallyadmitted by psychiatrists. A questionnaire survey was devisedand sent to all psychiatric trainees on the South-East Scotland rotation. The questionnaire contained a series of psychiatric vignettes representing conditions varying in severity of risk.

Seventy-eight per cent responded to the questionnaire. Trainees were more likely to admit patients representing a greater degree of risk irrespective of the gender of the patient.

The increasing admission rates for men with major mental illness is unlikely to be due to admission bias by trainees.

A confidential questionnaire was mailed to all trainers and trainees on the UCL/North London rotation (n=127), asking about the content and ways of improving supervision.

Seventy-six per cent of trainees received regular, timetabled supervision. Ninety-four per cent of trainees felt it was a good idea, but identified improvements, including more planning, setting an agenda and flexibility. There were differences between reports from trainers and trainees regarding the content of supervision. Respondents' comments are included.

Although supervision is popular and widely practised, this survey suggests that it is still not universally practised despite College stipulations. The content of supervision could be broadened to include more non-clinical matters such as teaching and careers guidance.

Description of the development of an outreach mental health service for homeless children and families, and presentation of referrals characteristics and management of 40 families.

Families became homeless predominantly because of domestic and neighbourhood violence. They were usually referred to the team for assessment of parents and children, without specific mental health concerns. A range of mental health interventions was offered, as well as liaison with other agencies.

The development of such services requires coordination of different agencies working with children and their parents. Also, designated staff and resources, because of the potential conflict with generic services.

The study aimed to identify factors delaying discharge of psychiatric inpatients from a learning disability service. A census was completed, categorising in-patients as unready for discharge (n=181); discharge planned within 12 weeks (n=22); or ready for discharge but experiencing delay (n=44), the latter were followed-up 16 months later.

Delayed patients were more disabled or disturbed and often awaiting adequate community provision. They were older, had been in hospital longer and were ‘informal’ admissions. At follow-up 23 remained in hospital, 21 of whom had been delayed by lack of placement.

De-institutionalisation has led to the expectation that more complex and challenging people be placed in the community. This study suggests the community to be, as yet, unready to cope with the needs of these service users.

A postal questionnaire was sent to 100 departments of psychotherapy within the UK in an attempt to gauge the use of psychotherapy services by patients in the third and fourth age.

Eighty-seven per cent of respondents felt that the needs of this group for psychotherapy were not met as well as those of younger people in their catchment areas. This is most marked in people over 65 years of age who are infrequently referred to psychotherapy departments. Suggestions are made for improving services.

The psychotherapy needs of this group need to be considered in service planning. All professionals need educating about the availability and applicability of the psychotherapies for the older patient. Without additional resources it seems unlikely that the needs of this patient group will be met.

The aim of this survey was to determine attitudes among consultants in different specialities towards the development of a reciprocal liaison service providing access for psychiatric patients to medical and surgical liaison services equal to the access of medical and surgical patients to psychiatric liaison services. All medical, surgical and psychiatric consultants in a district health service were surveyed, with a total response rate of 48%.

The mean number of medical and surgical patients requiring a psychiatric liaison service was 6%. The mean number of psychiatric patients requiring medical and surgical liaison services was 11%. Ratings overall for various components of the two types of liaison service were generally similar, with acute assessments and follow-up being given a high priority for both types.

As liaison services are developed, the notion of equity of access for all patients is paramount. Commissioning of such services should thereby specify the reciprocal nature of development. This survey shows that generally there is a positive attitude to the development of such a service.

This paper is based on two audits carried out in 1996 and 1998 atThe State Hospital, Carstairs. Each audit looked at anti-muscarinic drug use within the hospital, in relation to approved prescribing standards issued in 1996. All patients within the hospital on anti-muscarinic drugs were identified at the timeof each audit. These prescriptions were compared with the approved prescribing standards. In the 1998 audit additional information was obtained from the case notes and the consultants, when the approved standards were not met.

The percentage of patients on regular anti-muscarinic drugs, falling outwith the prescribing standards, reduced between the two audits. However, in 1998 a small number of patients were still outwith the approved prescribing standards set in 1996.

An improvement in the prescribing practice of anti-muscarinics occurred following the introduction of prescribing guidelines. However, the guidelines were not fully met in the 1998 audit. This demonstrates the need for further audit and continued monitoring of anti-muscarinic prescription at the State Hospital.