Despite widespread acceptance that the sexual history is an important part of psychiatric assessment, concern continues to be raised that such questions are often neglected. It has been suggested that one reason for this is the belief of staff that patients do not want to discuss sexual matters. The response of 65 out-patients to a questionnaire concerning their attitudes and expectations to being asked questions about sex is reported. The majority of patients expected there to be some inquiry about sexual matters. While detailed enquiry was not anticipated, patients stated that most questions would not make them feel uncomfortable. This study does not support the view that patients are reluctant to give a sexual history.

The first part of this audit looked at the demographics of young people presenting to Monklands Hospital and the quality of their assessment. Precipitating factors and past psychiatric history were enquired of in the majority of cases but there was a dearth of information regarding alcohol/drug use and family history. A checklist was devised with the aim of improving the quality of these assessments. The second part of the audit cycle completed one year later revealed considerable improvement in all categories. It is hoped that this will be maintained by displaying the checklist in the accident and emergency department and continuing to include teaching about this vulnerable population to all new medical and nursing staff.

This study aimed to describe the prevalence of dental pathology in patients receiving electroconvulsive therapy and to prospectively determine the incidence of dental complications arising during treatment. Of 30 subjects, 93% complained of a dry mouth and 83% were taking drugs with anticholinergic properties. A third wore dentures and the dentate population had a mean of 15 decayed, missing or filled teeth. Oral hygiene and periodontal condition was poor with one-third requiring scaling and 30% complex periodontal treatment. Temporomandibular pain followed 44% of treatments, and minor buccal lesions occurred in 22%. Greater emphasis must be placed on dental care, and guidelines are suggested to improve practice.

We visited Italy in 1995 as part of a National Health Service management learning network. We visited Florence, Prato and Arezzo in Tuscany; before moving on to Rome and Milan. L.W. had completed psychiatric specialist training in Italy, prior to doing so in England.

All 34 patients admitted from a central area of London over a 10-week period were identified. The 25 (73%) who were subsequently interviewed were questioned about their whereabouts at various points in the past. Eleven (44%) of the interviewed patients had arrived in the area within one month prior to admission, nine (36%) within the last week. Seven (28%) of the total were identified as not being the responsibility of the local authority. Patients who have recently arrived provide a significant proportion of the clinical workload in this area.

This study was undertaken to assess whether psychiatric patients respond more adversely to reading their own records than non-psychiatric patients. Seventy-three psychiatric out-patients and 84 out-patients with diabetes were posted their main clinical summary with a questionnaire about it. For seven of the eight questions, more than 70% of both patient groups gave favourable ratings. However, the psychiatric patients gave significantly less favourable responses than the patients with diabetes on five of the eight questions. Fourteen of 73 (19%) psychiatric patients were upset by reading the clinical summary about themselves compared with four of 84 (5%) patients with diabetes.

Sexual dysfunction is a widely recognised adverse effect of many psychotropic agents. Older antidepressants such as monoamine oxidase inhibitors and tricycles, particularly clomipramine, are known to engender sexual adverse effects. In depression, this problem is exacerbated by the occurrence of impotence and lowered libido as part of depressive illness itself. We examined evidence relating to more recently introduced antidepressants: selective serotonin reuptake inhibitors, moclobemide, venlafaxine, nefazodone, mirtazapine and reboxetine. We reviewed published trials and case reports collated from searches of Medline, PsychLit and Micromedex from 1985 to December 1997, and contacted manufacturers of new antidepressants and requested information from them.

A one-day audit in a learning disabilities hospital revealed 15 patients (9.4% of the hospital population) on hypnotic medication. Guidelines were then developed for the use of hypnotic drugs. An audit of hypnotic drug usage was repeated for the 12-month period of 1994 which revealed that five patients were started on hypnotics.

Following the recommendation by the College that all general psychiatric trainees have the opportunity for psychotherapy training, we describe a pilot scheme for supervised dynamic therapy, commenting on organisational and training issues.

In a nutshell, commissioners (i.e. health authorities) have a statutory responsibility to buy the best health care for a defined population with a defined amount of money. They also have a broader, but less well-defined, responsibility for health, as opposed to health care. There is no doubt that health care has a relatively small influence on health compared with deprivation, housing and unemployment, but in reality the majority of effort of commissioners focuses on health care.

All higher trainees in psychiatry are required to spend one day a week in research or further study. A cross-sectional postal survey was used to investigate how senior registrars use their allocated research time, and to identify specific difficulties that prevent successful research being carried out. The instigation of the specialist registrar grade offers the chance to improve trainees' involvement in research. This has implications for the design and implementation of postgraduate teaching on research in psychiatry.

The principle is less strange today than when it was first proposed, but making hospitals safe for patients is no easier. Stepping aside from one danger, one may fall into the path of another. Legionella risks can be avoided by higher water temperatures but this in turn introduces a risk of scalding. Security measures can protect the individual and work space but may compromise fire safety. This paper describes a similar problem of conflicting safety measures and its unfortunate consequences.

The ability of elderly patients to identify a nurse wearing a uniform as opposed to mufti was investigated together with the effect of administrator attire on the Abbreviated Mental Test score (AMT). Thirty-six out of 71 patients identified a nurse wearing mufti increasing to 59/71 when wearing uniform (P < 0.005). Patients rated by a uniformed nurse had significantly higher mean AMT scores (6.1) than when rated by a nurse in mufti (5.6) (P < 0.01), and this also had a significant effect on the sensitivity in predicting an organic diagnosis.

The views expressed are based on experiences of a second opinion appointed doctor and refer to neurosurgery for mental disorder. Here the general issues are sharpened by the necessity to certify informed consent and the likelihood of the alleviation or the prevention of deterioration. In an age of evidence-based medicine the criteria by which these issues are judged are critical and need to be generally agreed. The evidence needed in clinical reports and in certification is considered from theoretical and practical viewpoints and suggestions are made in reference to treatment at both new and established centres.

Idiopathic unconjugated hyperbilirubinaemia (Gilbert's syndrome) is a common benign disorder that, when seen in association with psychiatric illnesses, often leads to the inappropriate withholding of psychotropic medication. We describe three cases with Gilbert's syndrome and psychosis in which diagnosis of Gilbert's syndrome was delayed. This led to unnecessary investigations, further relapses and increased admissions to hospital. We emphasise the need for psychiatrists to be more aware of this benign condition.

In this paper concepts related to the field of non-linear dynamics and chaos theory are discussed, and their relevance to psychiatry is considered.

This article is one of a series dealing with training and employment in countries overseas, previous articles have covered Australia (Kisely, 1993) and Canada (Kisely & Jones, 1996). This paper updates an earlier report on New Zealand which was published five years ago (Timney, 1991). In particular it highlights important recent changes to registration procedures which will affect doctors wishing to go to New Zealand, for either temporary work experience or permanent settlement.