To ascertain the competence of voluntary psychiatric patients to consent to neuroleptic medication and whether there is a hierarchy of tests of competence. A prospective, observational study of consecutive, voluntary admissions to an acute ward using a questionnaire designed to test four levels of competence, the Mini-Mental State Examination and the Brief Symptom Inventory.

All subjects (n=40) could communicate a choice; 5% were competent at all levels. Tests were arbitrary and not hierarchical. Symptom relief/trust in doctors motivated most decisions to accept treatment.

The number and identity of individuals identified as competent will vary with the test set, and tests limited to cognitive criteria will not cover the complexity of the task.

This study examined the attitudes and knowledge of patients regarding their depot neuroleptic medication. All patients were attending a community mental health centre in Clydebank, Scotland.

Many patients had limited knowledge of their medication, its benefits and side-effects as well as the rationale for its use. The biggest gaps were found in patients' knowledge of the long-term side-effects of their medication.

Our findings raise doubts as to the capacity of some patients to give informed consent to their treatment. A number of steps are outlined in order to raise patients' standard of knowledge.

A randomised, blind comparison of a structured consent procedure against routine consent was conducted to determine whether it had any utility in improving treatment knowledge In patients receiving electroconvulsive therapy (ECT). Additionally we aimed to determine whether degree of cognitive impairment intelligence and severity of depression influenced recall of information.

Thirty-two subjects were investigated. Structured consent significantly improved the number of knowledge items recalled pre-ECT (P<0.05). Knowledge scores declined significantly after completion of the treatment course in both structured consent (P<0.05) and control groups (P<0.06). There was a significant correlation between Mini-Mental State Examination (MMSE) scores and the number of knowledge items recalled both pre- (r=0.43, P<0.05) and post-ECT (r=0.53, P<0.01).

Structured consent procedures may be a useful way of improving patient knowledge of ECT and merit further study. Low scores on MMSE should caution clinicians to take particular care when consenting patients to ECT.

To examine the onset and course of clinically observable improvement in patients receiving electroconvulsive therapy (ECT). A prospective design was used In which 19 consecutive patients receiving ECT were followed up from commencement to termination of ECT. The Clinical Global Improvement Scale was administered at every ECT session to monitor their Improvement.

Eleven of the 19 subjects Improved minimally and another subject Improved substantially after the first two ECT treatments.

ECT produces clinically observable improvement in depression within a few days of starting treatment perhaps earlier than is generally acknowledged.

To explore clozapine and atypical antipsychotic usage in England and Wales, particularly availability, restrictions on use and shifting of prescribing to general practitioners. To examine the hypothesis that respondents in acute trusts would encounter more restrictions. Method used – postal questionnaire sent to general psychiatrists derived from the 1996 Medical Directory.

There was an 80% response rate and over 90% of respondents used clozapine, with only 9% reporting any difficulty in obtaining it. Difficulty was not associated with any particular type of trust. Only about 4% of respondents suggested that general practitioners regularly took over the prescribing costs of the drug.

Optimistic, with widespread usage and few difficulties in obtaining clozapine. General practitioner prescribing is still very low and needs to increase.

To monitor the effect of the introduction of olanzapine under naturalistic conditions to patients with severe and enduring mental Illness in three rehabilitation services.

Thirty patients were prescribed olanzapine during the first six months of its launch. Objective ratings were used. Six months later, one-third were no longer on treatment one-third were unchanged and one-third had made useful clinical gains.

Patients who have suffered from neurological or prolactin-related side-effects may benefit from treatment with olanzapine. Attitudes to treatment and adherence may improve.

To investigate whether changes in antidepressant prescribing have been associated with alteration in suicide rate for the period 1989–1996 in Northern Ireland. Data for antidepressant prescribing were obtained from a central unit, for Northern Ireland, using the defined daily dose system for each of the above years. The number of recorded cases of suicide and undetermined death were also obtained for this period, from Northern Ireland coroners.

There was no evidence of an association between suicide rate and antidepressant prescription (r2=0.019, F test=0.115, P=0.74), despite antidepressant use more than tripling over the study period.

Even substantial increases in detection and treatment of depressive Illness may not impinge on suicide rate. It Is also possible that suicide rate may be a very poor marker of the benefits of antidepressant treatment.

A total of 384 incidents of violence against the person (six ‘serious' and 378 ‘mild’), by adult in-patients in general psychiatric units (GPUs) and learning disability units (LDUs) in 10 National Health Service trusts in the Anglia region, were evaluated by Interviews with staff and examination of records.

The findings, when compared with standards derived from previous recommendations, showed deficiencies in the documentation of incidents (there was no satisfactory written record of physical restraint for 97% of incidents in GPUs and 86% in LDUs), in the training of staff in ‘control and restraint’ procedures (If two or more staff were involved In physical restraint, for 3% of incidents in GPUs and 100% in LDUs, the staff had received no training within the previous 12 months) and in policies for victim support (there was no written policy that included procedures for victim support in relation to 84% of incidents in GPUs and 44% in LDUs).

Trusts should consider reviewing their policies on the prevention and management of violence, particularly in relation to staff training.

A questionnaire survey of attitudes to Continuing Professional Development (CPD) was addressed to all 58 non-training grade psychiatrists working in a large teaching community mental health trust. Ninety-three per cent provided responses. Views were sought on the value of various teaching methods, how CPD should be organised, what barriers to participation colleagues encounter and whether CPD should be made mandatory.

These showed strong support for the personal study element of CPD, indicated the range of other teaching modalities used by practitioners including industry supported symposia and found a significant majority in favour of making CPD mandatory. Pressure of time was the main obstacle to participation for most.

The survey provides pointers for the key Issues which are likely to affect the readiness of practitioners to participate in CPD, as well as informing decisions on the type of ongoing educational activity that psychiatrists see as relevant.

The specialist registrar (SpR) grade was introduced in 1996, taking the place of the senior registrar (SR) grade. We surveyed higher trainees in Scotland in order to draw comparisons between the two grades and assess satisfaction with the changes. A postal questionnaire was sent to all higher trainees (n=129) in Scotland seeking Information on structure of training, work patterns and views.

Sixty-two per cent of trainees responded. There was little difference in the activity and structure of training between SRs and SpRs. Seventy per cent of responders felt that the SpR grade had not improved training.

The survey uncovered dissatisfaction with the new grade, but little objective evidence of differences between SRs and SpRs. More flexibility for time in higher training and restoring the SR title would help to improve morale.