There is poorer control of hyperactivity symptoms in community clinics than research settings, and difficulty in detecting such symptoms without standardised measures. Hyperkinetic children (n=29) were evaluated at follow-up using the parental version of the Strengths and Difficulties Questionnaire (SDQ) and, independently, routine clinic reports to test the value of a parental questionnaire.

The parental SDQ identified symptoms in more patients (25, 86% v. 13, 45%), but high levels of symptoms did not necessarily imply impairment. Even clinically identified hyperactivity provoked no change in treatment.

Parental questionnaires alone are unlikely to improve clinic practice. Research is needed into what factors influence clinical decisions regarding treatment maintenance for hyperkinesis, and the adaptation of structured protocols from major research trials should be considered.

The aim of the survey was to assess the attitudes of specialists in old age psychiatry towards the use of clozapine in elderly patients. A postal questionnaire was sent to a random sample of 155 consultant old age psychiatrists in England.

The response rate was 87%. A majority of respondents felt that clozapine had a useful place in the treatment of elderly patients, although they expressed concerns about the lack of published data and about safety and practical difficulties in monitoring. Prescribers of clozapine (n=45) were significantly more positive about its role in treating older patients than those who had not used it.

The findings suggest that familiarity with and confidence in clozapine and practical difficulties in monitoring are important determinants of its use in older patients.

A national survey of consultants in child and adolescent psychiatry was conducted to explore their attitudes to copying correspondence to patients and their families and the impact of recent national guidelines on practice.

Of the 290 respondents, 261 (90%) agreed in principle with copying letters to patients but only two-thirds (n=186) were routinely doing so. Nearly half (n=139, 48%) had changed their practice as a consequence of the guidelines. The majority (n=160, 55%) felt that the guidelines lacked clarity with regard to the complexities of child psychiatry and a third (n=93, 32%) had experienced difficulties when copying letters to patients.

This survey highlights some of the benefits and risks involved in child and adolescent psychiatry when letters are routinely shared with families. Increased openness and transparency can enhance the therapeutic relationship; however, given the complexities and sensitivities implicit in child psychiatry, there is a risk of jeopardising engagement and alienating the family.

Annual audits of the enhanced care programme approach (CPA) were conducted from 2002 to 2005 to evaluate and improve the implementation of CPA in two inner-London community learning disability services. The CPA standards included those stipulated by the Department of Health. The notes of all patients on enhanced CPA were analysed using a structured data collection form.

There was a gradual improvement in the attainment of targets by both services. Areas of strength included allocating a date for the next CPA review, crisis plans and documentation of service users' comments. Areas of weakness included completion and review of risk assessments and the availability of a care plan for the previous 6 months.

Completing the audit cycle and reauditing improves attainment of targets and encourages service development, but further progress is required.

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.