This study explores knowledge and uptake of the voting rights of adult in-patients in the 2010 UK general election. A clinician-completed survey was used.

Eligible to vote psychiatric adult in-patients were half as likely to register as the general population and half as likely to vote if registered. Nine out of ten of those unregistered cited a lack of knowledge of their eligibility to vote or of the registration process. Long-stay patients were particularly disenfranchised.

Many patients and staff remain unaware of the new rules which have given a greater proportion of in-patients the right to vote and have simplified the registration and voting processes. This information barrier may be addressed in future elections by providing timely written information to both patients and staff. Once registered, patients may need further support to overcome practical and psychological barriers, and cast their vote.

To test whether medical students find case-based discussion of child psychiatry more educationally stimulating and more enjoyable, and whether this leads to greater knowledge acquisition than traditional didactic lectures. Four cohorts of Cambridge medical students (n = 54) were randomised to case-based discussion or traditional didactic lectures for two topics in their psychiatry placements. Enjoyment and stimulation were determined by feedback forms; knowledge acquisition was tested by an end-of-placement exam.

Students in case-based discussion groups scored significantly higher than students in the lecture groups in the extent to which they enjoyed the teaching session (P = 0.006); the extent to which they understood the principles of management of real-life patient problems (P = 0.044); and their interest in looking up further information (P = 0.003). There was no significant difference in exam performance (P = 0.9).

Medical students find case-based discussion more engaging and enjoyable than didactic lectures, with no reduction in exam performance.

Child and adolescent mental health services in north-west England (n=21) participated in a prospective collection of information regarding all instances of new prescribing of medication over the 6–month period September 1999 to February 2000.

A total of 478 new prescriptions were issued to 411 individuals. Eight prescriptions (2%) were for an unlicensed drug and a further 188 (39%) were of licensed drugs but used in a manner outside of their product licence.

This level of unlicensed and outside-licence prescribing is similar to levels previously found in studies both within paediatric practice and in adult mental health practice. Anxiety about excessive beyond-licence prescribing by child mental health services is unlikely to be justified.

A postal questionnaire was sent to consultant psychiatrists in the West Midlands to establish their current ward round practice. This questionnaire addressed ward round etiquette, practical issues and educational function. Consultants received only one mailing.

A total of 96 (out of 139) consultants replied (69% response rate). The majority of consultants saw patients on the ward round (97%) and all consultants introduced both themselves and team members to the patient; 72% explained the purpose of the ward round. A median of seven professionals attended the ward round with psychology (6.5%) and pharmacy services (0%) being underrepresented. When consultants added comments, the recurrent themes were that ward rounds were an effective use of professional time but were often daunting for patients.

Our results indicate some uniformity in the conduct of ward rounds. The lack of representation at ward rounds for certain professional groups may adversely affect the range of opinions and therapies for patients. Changes could be made to incorporate the views of users, which would make ward rounds more productive for users and professionals.

Postal questionnaires were sent out to 66 learning disability psychiatrists to assess their knowledge and experience of the Mental Capacity Act 2005.

A response rate of 55% (n = 36) was achieved; 22 (61%) respondents felt that patient care had improved; 16 (44%) felt workload had increased. Despite 79% (n = 23) of the respondents feeling that the training for the Act was adequate, only 19% (n = 7) were aware of the situations where patients had to be referred to the Independent Mental Capacity Advocate (IMCA) service and only 53% (n = 19) were aware that the Act currently does not cover patients who fall in the ‘Bournewood gap’.

Learning disability psychiatrists are still not conversant with significant parts of the Act and this raises questions about the adequacy of the training delivered. Implementing the Act should improve patient care but will have implications for the workload of professionals.

By use of a telephone survey, we aimed to investigate liaison psychiatry services of all 29 general hospitals in Greater London. We specifically enquired about services to accident and emergency (A&E) departments.

We identified wide variations in staffing, working hours and patient groups seen. Fourteen services (48%) worked over 24 h and 4 (14%) had specific A&E teams. Twelve services (41%) had established or planned working links with community crisis services.

Generally staff numbers fell below national recommendations and there were frequent gaps in service provision. The recent focus on emergency care has lead to an increase in A&E services, but there is a risk that liaison psychiatry services for other general hospital patients are being neglected.

Depression in first-episode psychosis (FEP) is highly prevalent and associated with poor outcomes; it has become increasingly recognised and adopted in national and international guidelines for psychosis. Using a 26-item questionnaire, this study aimed to explore if this shift has led to greater recognition among UK psychiatrists, and more effective management of depression in FEP.

Of the 297 respondents, 54.4% observed depression occurring in chronic psychosis, with the least number of respondents (17.7%) identifying depression occurring frequently during FEP. Although there was reasonable agreement in the use of antidepressants as a first-line treatment for depression (70% prescribing antidepressants), there was uncertainty around assessing depression and delineating from psychosis symptoms, and particularly negative symptoms.

Evidence-based treatments for comorbid depression in psychosis will lead to clearer national guidelines, allowing for optimal management of depression in early psychosis, potentially leading to improved outcomes for these individuals.

Medication with anticholinergic action is associated with potentially serious adverse effects in older people. We present an evaluation of a novel anticholinergic burden scale introduced into routine practice in older adult services in the South London and Maudsley (SLaM) NHS Foundation Trust. Our aim was to assess whether this tool improved the accurate identification of anticholinergic medication and guided safer prescribing in cognitively vulnerable older people.

The introduction of the anticholinergic effect on cognition (AEC) tool into clinical practice led to an increase in the identification and reporting to general practitioners of anticholinergic medication from 11 to 85% of cases (P = 0.0015).

Application of the AEC tool led to improved detection of anticholinergic medication and advice to primary care on when a medication review is necessary. This is an important step towards improving the safety of prescribing in this patient group.

Community treatment orders (CTOs) have been in used in England and Wales since November 2008; however, their effectiveness has been debated widely, as has the question of which methodology is appropriate to investigate them. This paper uses national data to explore the use of CTOs in England.

About 5500 patients are subject to CTOs at any one time. Each year, ~4500 patients are made subject to a CTO each year and ~2500 are fully discharged, usually by the responsible clinician; fewer than half of CTO patients are recalled, and two-thirds of recalls end in revocation. The low rate of CTO discharges by mental health tribunals (below 5%) suggests that they are not used inappropriately.

The introduction of CTOs in England has coincided with a reduction in psychiatric service provision due to the economic downturn. Pressures on services might be even more severe if patients currently subject to CTOs instead needed to be detained as in-patients.

None.

The aim of the study was to survey strategies for dealing with patients who refuse clozapine blood tests or tablets. One hundred and twenty-five psychiatric intensive care unit consultants were sent a questionnaire.

Thirty-nine (31%) questionnaires were returned. Opinions and practices were diverse ranging from uncertainty around the legal right to enforce venepuncture, to the practice of slipping clozapine into a patient's drink without their knowledge.

There is need for an open debate of the relevant legal and ethical issues.