We aimed to update Information on the development of old age psychiatric services using a postal survey of consultants.

The response rate (51%) was lower than previous surveys in the 1980s. Senior academic appointments showed little increase and academic posts were largely National Health Service (NHS) funded. Services had smaller catchment areas and increased numbers of staff in medicine, nursing and social work, but not in occupational therapy, physiotherapy and psychology. Relative workload was increasing and most services included early-onset dementia. There was a decrease in provision of NHS long-stay beds with only marginal changes in other facilities.

Services were offering more to patients than previously. Weakness in academic development may cause problems for the future; the results suggested that recruitment in some disciplines may already be problematical. There is a need to develop the role of NHS long-stay facilities.

To test the impression of wide national differences in the use of deterrent medication in the treatment of alcohol dependence, data showing comparative sales of disulfiram in 13 countries were obtained.

Sales in Britain were lowest, and less than a tenth of those in Denmark. Rates bore no relation to alcohol sales or an index of alcohol-related problems in the 13 countries.

British doctors may apply a particularly cautious risk/benefit ratio for disulfiram. The disparity may also reflect the predominantly nonmedical approach to treating alcohol dependence in Britain.

To identify and reduce the number of patients receiving depot neuroleptics above the British National Formulary maximum. The medical records were scrutinised and individual consultants were informed of the results.

For the team involved in this audit there was a significant reduction in the prescription of high-dose depot medication, but this did not generalise to other teams.

Different teams should repeat the audit and a new depot card has been developed.

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.

A survey of recorded refusal of drug administration to patients in a psychiatric hospital over a six-month period in 1996 was made using drug administration records. For comparison 150 patients were randomly selected from the 1975 drug sheets and instances of drug refusal noted.

Eighteen per cent of patients refused drugs on at least one occasion, and of those over 65 years of age 26.2% refused drugs. All the main diagnostic categories and groups of drugs were involved. of the 150 patients studied from 1975 only four refused drugs.

Doctors should be alert to the possibility of refusal of drug treatment in a wide range of psychiatric conditions. When refusal occurs interventions are likely to be necessary, including a review of drug treatment.

We describe a new home treatment service established In one sector of the city of Bradford.

There was a tendency for the patients hospitalised from this sector to have more unstable housing backgrounds. It was found that a higher percentage of patients with diagnoses of serious mental Illness were cared for at home.

We argue that even in the presence of home treatment, there Is a continuing need for asylum. However, we make the case that this does not always have to be provided In a medical environment.

An examination of the activities of a district-wide dedicated admission unit for poisoned patients in Cardiff, Wales, between 1987 and 1997. Number of admission episodes, gender, drugs taken. intent, psychiatric diagnosis and disposal were recorded.

Although the number of admission episodes almost doubled over the 10–year period, the median length of stay fell by almost half.

The results suggest that a dedicated unit is a cost-effective model for the management of poisoned patients.

After gaining the impression that our discharge summaries were too long for local general practitioners (GPs), we proposed to produce an abbreviated summary. We sent a questionnaire to a sample of GPs asking which aspects of the current summary were helpful.

Although many GPs considered the summary overly long, a majority considered all the items to be at least Very helpful’.

Although previous work on discharge summaries has indicated a demand for brief, focused reports it is important to establish local GP priorities before planning changes.

A survey of the management of all 84 restricted hospital order in-patients with schizophrenia, resident in any hospital in England and Wales, during May 1997, with an index conviction for a contact sex offence against a woman, was carried out.

Treatment concentrated upon pharmacological therapy for psychiatric symptoms. Only a small minority of patients received specific psychological therapy to address sexual offending issues, despite responsible medical officers reporting that over four-fifths of patients continued to have marked social or sexual difficulties relating to women, and that non-psychotic factors appeared to make a significant contribution to index sexual offending in about three-quarters of cases.

Many in-patients with schizophrenia who have committed sexual offences may not be receiving optimal management and more research is required to elucidate their treatment needs.

The purpose of this paper is to review current evidence and opinion with regard to the long-term treatment of unipolar depression. The method employed was a Psychlit search using the search items long-term, maintenance, treatment and depression.

The search yielded 91 articles.

Unipolar depression is frequently recurrent and sometimes a chronic illness. The paper identifies those at greatest risk of recurrence. It goes on to examine strategies to prevent relapse and for prophylactic treatment. It concludes that continuation treatment should be sustained at full dose for 4–6 months after full remission of symptoms. Where depression is highly recurrent the acute phase dose should be maintained in the long-term.