To report on the use of atypical antipsychotics in one health district by examining secondary care prescribing patterns for these medicines in North Staffordshire between 1994 and 2001. With one exception, these drugs were licensed solely for use in schizophrenia during the study period.

A total of 502 patients were initiated on atypical antipsychotics in the study period. Of these, 297 (59.2%) had a diagnosis of schizophrenia (ICD–10 codes F20–29). Off-label prescribing was common, but psychiatrists were least likely to prescribe clozapine off-label (2.2%). Affective (18.4%) and organic disorders (12.4%) were the main disorders treated off-label. Olanzapine had the highest off-label use (44.5%).

The high off-label use of atypical antipsychotics has clinical and economic implications. Although off-label prescribing may be in the patient's best interests, they should be informed and give their consent. Commissioning bodies, such as primary care organisations, are basing their budgets on guidance from the National Institute for Clinical Excellence, which can have implications for funding this off-label use.

We conducted an anonymous survey of support workers to examine attitudes to people with different types of mental illness. Scores were based on a previously demonstrated stigmatisation score.

A total of 133 questionnaires were returned, representing 27% of all possible recipients. Fewer than 20% of respondents considered people with schizophrenia to be dangerous, although nearly half thought that they would never fully recover. More stigmatising responses were demonstrated to alcohol and drug addiction than to other disorders.

Support workers who spend large amounts of time with people with mental illness, in particular schizophrenia, have a low perception of their dangerousness. This may have implications for planning further measures to reduce stigmatisation.

A survey was conducted to determine the experience of verbal and physical abuse among specialist registrars and the availability of training on managing abusive patients. A self-report questionnaire was sent to all specialist registrars working in the Northern Deanery.

Completed surveys were received from 30 out of the 49 trainees (61% response rate). Twenty-three respondents (77%) reported being abused; all reported verbal abuse and 2 (9%) reported physical abuse. The experience of trainees of abuse differed between White doctors and those from other ethnic groups. The majority of trainees had received no training to deal with abuse.

In view of the high prevalence of abuse experienced by trainees, interventions to prevent both verbal and physical abuse should be identified. There should also be formal support for managing abuse and improved recording of abusive incidents.

To understand the benefits and limitations of using psychological formulations for patients with severe mental illness, a qualitative study of staff views was conducted, based on semi-structured interviews with 25 staff working in a high-dependency rehabilitation service.

Participants believed that formulations benefited care planning, staff–patient relationships, staff satisfaction and teamworking, through increasing understanding of patients, bringing together staff with different views and encouraging more creative thinking. They particularly valued meeting together to develop the formulations. Some staff accepted formulations as tentative and provisional, whereas others regarded them as statements of conviction.

The study suggests that using psychological formulations in the care of psychiatric patients may well be valuable, but needs further exploration.

A postal survey was conducted to determine what proportion of psychiatric specialist registrars working in Scotland (n=119, excluding those specialising in psychotherapy) met the requirements for experience in psychotherapy. Since 2004, this has been a compulsory part of eligibility criteria for the MRCPsych part II examination.

Two-thirds of those surveyed responded. One-third of respondents met the Royal College of Psychiatrists' requirements for psychotherapy experience. Half the respondents reported competence in at least one modality of psychotherapy. Four-fifths of respondents were interested in gaining further experience and training, two-thirds in developing a special interest and one-quarter in dual training, in at least one modality of College psychotherapy. There was no significant association between adherence to the requirements and self-perceived competence, qualification or the wish to gain further training and experience in psychotherapy.

The majority of trainees, even those interested in psychotherapy, still fail to meet College requirements. Many trainees would appreciate an opportunity to gain greater depth of psychotherapy experience, in addition to gaining broad experience of various aspects of psychotherapy as required by the College.

To determine the opinions of psychiatrists on mental illness among themselves and their colleagues a postal survey was conducted across the West Midlands.

Most psychiatrists (319/370, 86.2%) would be reluctant to disclose mental illness to colleagues or professional organisations (323/370, 87.3%). Their choices regarding disclosure and treatment would be influenced by issues of confidentiality (n=245, 66%), stigma (n=83, 22%) and career implications (n=128, 35%) rather than quality of care (n=60, 16%).

The stigma associated with mental illness remains prevalent among the psychiatric profession and may prevent those affected from seeking adequate treatment and support. Appropriate, confidential specialist psychiatric services should be provided for this vulnerable group, and for doctors as a whole, to ensure that their needs, and by extension those of their patients, are met.

This study aimed to determine the proportion of patients hospitalised with mania who had capacity to consent to treatment, to determine the predictors of capacity and to explore the relationship between detained status and capacity. Fifty in-patients with mania participated in a clinical interview to assess capacity.

Nineteen patients (38%) had overall capacity. Capacity was predicted by higher IQ, lower severity of manic symptoms and more episodes of depression; it was not related to voluntary or detained status. The domains of capacity were not hierarchical.

Many patients hospitalised with mania have capacity to make an informed choice regarding treatment even when compulsorily detained. Their capacity should be reviewed frequently and measures adopted to enhance capacity.

A questionnaire was sent by post to 185 psychiatrists in Devon and Cornwall to investigate training in the assessment and management of drug-related movement disorders and current training needs.

Responses were obtained from 143 psychiatrists (77%). Formal training was reported by 67 out of 140 (48%). Only 26 out of 142 (18%) had received formal training in the use of rating scales, which were rarely used. The mean level of satisfaction with training received was below the mid-point on a 5-point scale at 2.76 (s.d.=1.23). Mean levels of confidence in the assessment and management of drug-related movement disorders were just above mid-point at 3.25 (s.d.=1.04) and 3.16 (s.d.=0.99) respectively. Specific training was thought to be necessary by 135 out of 141 psychiatrists (96%) and there were high levels of interest in further training, particularly from those below consultant grade.

Drug-related movement disorders affect patients' adherence to medication and their quality of life. Psychiatrists need more structured clinical training in assessing and managing these disorders in order to provide the best clinical care.

Referrals to a specialist psychotherapy service were audited to measure the average waiting time for a first appointment and the proportion of patients waiting longer than 13 weeks. Recommendations for improving service delivery were made, an action plan implemented and the audit repeated.

In 2003, an initial audit of 355 referrals was completed using data from 2002. This found a mean waiting time to first appointment of 11.5 weeks with 30% of patients waiting longer than 13 weeks. In 2004, following implementation of the action plan, a re-audit of 200 patients found that the mean waiting time from receipt of referral to first appointment had reduced to 6.7 weeks with only 2.3% waiting more than 13 weeks.

Audit can improve the efficiency of service delivery in a specialist psychotherapy service. However, this may require that psychotherapists review traditional ways of working. Also, it is important that they feel personally involved in the audit process.

Academic programmes are mandatory in child psychiatry specialist registrar training. A postal questionnaire survey was undertaken to explore the views of specialist registrars and academic programme coordinators identified nationally with regard to their local academic programme.

Sixty per cent of specialist registrars (152 out of 253) and 90% of coordinators (17 out of 19) responded. All schemes offered an academic programme with protected time. Teaching methods were diverse, and satisfaction varied within and between schemes, with trainees reporting greater satisfaction associated with active involvement of coordinators.

The authors provide recommendations for local planning of academic programmes. The authors request the assistance of CAPSAC in standardising the appointment and training of coordinators and facilitating their release from clinical commitments.

All patients attending the local supervised drug consumption clinics were surveyed over a month. They were asked via a questionnaire to list the risks of injecting drugs, particularly the symptoms and consequences of deep vein thrombosis (DVT). Of 69 patients surveyed, 46 agreed to take part.

Only 9 patients (20%) had never injected drugs, whereas 16 (43%) of those injecting had injected into the groin; 10 patients (22%) had experienced a venous thrombosis themselves, and 35 (76%) knew of someone who had. Only 30 (65%) knew what a clot or thrombosis was. Pain and swelling were the most commonly reported symptoms, but few drug misusers knew of other symptoms. The best informed were those who had experienced thrombosis themselves recently.

The results indicate an apparent lack of basic knowledge about the risks of DVT in this sample of drug misusers, and a need for some new initiatives to address health education in this area for all drug misusers.

To describe a targeted domiciliary drug treatment service for dementia and to establish clinical outcomes for its patients. All new referrals in a 6-month period were included. Data on clinical and demographic background, service performance and cognitive, functional and behavioural outcomes were recorded.

Of 96 patients initiated on antidementia drugs, most had dementia of mild to moderate severity, and had heterogenous diagnoses. Significant improvements in cognition, behaviour and function were found.

A dedicated domiciliary drug treatment service for dementia achieved high levels of clinical activity and outcomes at least as good as clinical trials. This service model may be an attractive choice.

Previous studies have suggested that despite the cost of attendance at postgraduate cognitive–behavioural therapy (CBT) courses, psychiatrists are unable to engage in CBT after qualification. A postal survey of psychiatrists with postgraduate CBT training currently practising in Scotland was performed to assess the levels of training and supervision that they provide, therapeutic CBT activity, and supervision and continued professional development that they receive.

Of the 58 psychiatrists, 51 replied to the survey (88%). Less than half of the respondents supervised other staff. Although 43 (84%) engaged in some therapeutic CBT activity, only 25 (49%) received supervision for their own practice. The main reasons given for not engaging in CBT therapeutic activity were that there was inadequate ‘protected time’ and that CBT had not been included in ‘job plans'.

Psychiatrists can help to disseminate CBT skills. To do this, they require personal supervision, and time for the development and maintenance of therapeutic skills as well as for the training and supervision of others. This survey builds on the results of others and indicates that these requirements are currently being inadequately met.

The aim of the study was to elicit the views of senior house officers in psychiatry across London regarding the factors that influence their decision whether to pursue a career in child and adolescent psychiatry. Postal questionnaires were sent to a random sample of all senior house officers on London psychiatry training schemes.

Of the respondents who recalled being taught child psychiatry at medical school, 91% found it interesting and 73% found it useful. Of those who recalled having such teaching during psychiatric training, 90% found it interesting and 85% found it useful. However, this had no significant impact upon subsequent career choice. Experience of working as a senior house officer in child psychiatry did influence future career intentions. Trainees who identified such placements as providing good clinical experience or job satisfaction were significantly more likely to consider the specialty for a future career.

Consultants and managers should create and maintain senior house officer posts that will encourage trainees to perceive the specialty as a future career.

We surveyed old age psychiatrists in the north-east of England to determine what they considered relevant indicators of driving ability. The survey asked about their satisfaction with the current Driver and Vehicle Licensing Agency (DVLA) procedure of assessing competence to drive in patients with dementia and how they thought this could be improved.

Fifty-seven out of 76 psychiatrists (75%) responded; 26 (45%) respondents thought the forms issued by the DVLA were unsatisfactory but 32 (57%) were satisfied with the eventual decisions made about individual patients. Factors thought to be relevant indicators of driving ability were occupational therapy (n=46, 81%), neuropsychological assessments (n=43, 75%) and carer's report of driving (n=48, 84%). Factors thought not to be relevant were patient's report of driving ability (n=13, 23%) and the Mini Mental State Examination (n=21, 38%).

The current system for determining driving ability in people with cognitive impairment and dementia was felt to be unsatisfactory. A multidisciplinary approach and use of on-road driving assessments may improve decision-making.