To develop and introduce a drug treatment protocol for schizophrenia and to evaluate its effect on prescribing. Prescribing of antipsychotics was audited in January 1998. A prescribing protocol was then developed by a collaborative process involving all medical staff, and introduced in September1998. A second prescribing audit was conducted in February 1999.

The proportion of patients prescribed atypical drugs increased from 16.6% to 25.5%. Co-prescription of atypical and typical drugs was relatively uncommon compared with findings of other prescribing surveys. The use of anticholinergic medication was significantly more likely in patients receiving regular typical drugs alongside atypical agents than in those receiving atypicals alone.

Widely agreed prescribing protocols may promote improved prescribing practices. Co-prescription of atypical and typical drugs should be discouraged.

Electroconvulsive therapy should be effectively monitored and seizure duration accurately ascertained. We observed the seizure duration in both lower and upper limbs using the Hamilton ‘cuff’ method.

Thirty-nine seizures in 19 patients were observed. There were no statistically significant differences between cuffed and uncuffed limbs, nor between upper and lower limbs.

Alternatives to the Hamilton cuff method to observe seizure duration need to be considered.

Changes in higher specialist training in the UK have led to a revision of training guidelines in child and adolescent psychiatry. This survey studies trainees' experiences and attitudes in the light of these changes. A questionnaire covering training attitudes and experiences was distributed to all higher specialist trainees in child and adolescent psychiatry via their programme directors.

Eighty-eight per cent of trainees responded. Although most training experiences are well provided, there are gaps in provision in specific areas, including research and teaching. Dissemination of information about aspects of training requires improvement and clearer feedback on training could be given.

The implications for training in child and adolescent psychiatry and higher specialist training in general are discussed.

A prospective study comparing initial electroconvulsive therapy treatment doses determined by empirical dose titration with estimates derived from two simple dose prediction methods and a fixed-dose regimen (275 mC).

Thirty-three patients had seizure thresholds between 25 mC and 403 mC. The dose titration method led to a mean initial treatment dose of 195 mC that was intermediate between those predicted by the age method (275 mC) and the half-age method (137 mC). Estimates were within acceptable limits in 33% of cases for the age method, 64% for the half-age method and 40% for the fixed-dose method.

Either dose prediction or dose titration methods may be more appropriate in different clinical situations. The half-age method appears to be a more accurate predictor of optimum initial treatment dose.

To investigate the recording of Mental State Examination (MSE) findings by psychiatric trainees as well as dating, timing and signing of entries into the clinical record. Data were collected from randomly selected case notes in three acute psychiatric units.

There was an initial decline of MSE recording from 69% to 58% in the first re-audit. Introduction of a standardised format and involvement of consultant trainers in the supervision of MSE recording led to an improvement to 83% in the secondre-audit. Adherence to medico-legal standards also improved.

The introduction of an MSE format and consultant supervision of records improved the standard of MSE recording as well as basic medico-legal requirements by psychiatric trainees.

To determine the preference of flexible trainees in psychiatry for consultant posts. A questionnaire survey was conducted among all flexible trainees in psychiatry in the West Midlands Region.

The overall response rate was 19 out of 21 (90%). The majority 15 out of 19 (68%) hoped to gain such a post at the end of their training. Of those wanting a consultant post, 15 of the 19 (79%) would only consider working part-time. If such a parttime consultant post was not available, 12 of the15 (80%) said they would considera non-career grade post.

In the West Midlands Region there has been an exponential growth in the number of flexible trainees. Approximately a third are within psychiatry alone and most wish to continue flexible working patterns as consultants. This has major workforce planning implications for the future.

This paper describes the validation of self-report of risk by patients with borderline personality disorder (BPD) as compared with the judgement of experienced psychotherapists in regular contact with them. The aim was to validate the Clinical Outcomes in Routine Evaluation System (CORE) self-report in order to be able to use it to monitor risk change for patients with BPD in psychotherapy and general psychiatric settings.

There was significant separation correlation between CORE risk sub-scales for self-harm, suicide and risk to others and therapists' estimation of significant risk v. no significant risk.

Using the cut-offs described, we suggest that the CORE questionnaire risk sub-scales can be used to assess significant risk for patients with BPD in psychotherapy, and in psychiatric and community health teams. The sub-scales should also prove valuable in allocating Care Programme Approach status.

The first 14 months of a consultantled weekly group for in-patients in a medium secure unit are described.

The group's (voluntary) attendance averaged more than 60% of the team's patients over 50 sessions. The weekly attendance increased significantly in the second seven-month period compared with the first (mean numbers of patients (s.d.) 10.4 (0.6) v. 8.1 (0.8)). An eclectic approach, with supportive, educational and interpretive elements, evolved as most suitable for the heterogeneous group of patients involved.

The group represented a safe, efficient and practical way of responding to patients' wishes for consultant contact, information, support and also of observing the individual's mental state and ability to interact in a complex social setting.