We argue the case for In-patient liaison psychiatry In the UK. We undertook a case note review of the characteristics of a consecutive series of in-patient and day patient admissions to a specialist liaison psychiatry unit in Leeds. We reviewed the literature on in-patient units for the treatment of similar patients, most of which came from the USA.

Physical morbidity was high in the sample. Forty-four per cent had been admitted for physical problems in the year before admission to the unit. Twenty-three per cent were taking five or more drugs for physical disorders at the time of admission, 86% were not in paid employment at the time of admission. Treatment involved integrating treatment for physical Illness, and physical and psychosocial treatments for mental disorder. We identified no reports of in-patient units in the UK doing similar work.

In-patient liaison psychiatry is neglected in the UK, to the detriment of a small but important group of patients with coexistent severe physical and mental disorder.

To discuss the working of a new paediatric liaison service. To review paediatric referrals to a child and adolescent mental health service (CAMHS) 21 months before and 21 months after the establishment of this service.

One hundred and eighty-three children were discussed in the 21 months after the new service was set up. There was a rise in referral to CAMHS from 72 to 120. Non-attendance rates from paediatric referrals also rose. Likely reasons for these changes are discussed, and include an increase in referrals of children with somatisation.

Interdisciplinary liaison appears to carry many advantages, but is likely to increase referral rates to the CAMHS. This has both clinical and resource implications.

Within a mental health service for children and their families a range of treatment options should be offered. We discuss the organisation of family therapy as one mode of treatment within a generic child and adolescent mental health service. It is based upon a review of all referrals during a 12-month period (April 1997–March 1998).

This review showed a high rate of non-attendance for first appointments, that the family therapy offered an effective forum for assessment and that a brief focused model of intervention could be effective within a generic service.

This review has lead us to modify our deployment of family therapy as a treatment option: this modification has implications in terms of resource utilisation and of the clinical use of family therapy.

A one-in-five random sample (n=104) of practitioners approved under Section 12(2) of the Mental Health Act 1983 in the West Midlands was selected. Opinions were sought on issues relating to current law and potential reform.

Eighty-three (80%) doctors were interviewed. Over half (52%) stated that the term ‘mental illness' in the Act was unsatisfactory. Two-thirds (68%) specified the need for a review of legislation relating to treatment in the community.

There was a diversity of views. This is likely to be reflected in the clinical practice of those interviewed. Many respondents believed that there was a need for reform in specific areas of the Act.

To describe the implementation of a plan to use a validated outcome measure in the care and treatment of people with severe mental illness within a district general hospital psychiatric service. Multiple techniques were necessary to promote actual change of practice.

A survey of practice found 77% of full Care Programme Approach patients to have recorded Health of the Nation Outcome Scales (HoNOS) scores in their care plans one year after the beginning of the implementation plan.

It is possible to incorporate the use of HoNOS in to everyday practice but it takes a lot of time, effort and resources. Mental health services may require a clearer indication from the NHS Executive regarding the use of such outcome scales before committing themselves.

To assess the extent of user involvement in care planning, from the users' perspective. Fifty Care Programme Approach (CPA) meetings across five consultant teams were included using quota sampling. Data concerning user involvement was collected by direct observation, semi-structured interviews with users and keyworkers and a review of CPA documentation.

User involvement in needs assessment and decision-making was poor, as was knowledge of care planning and information provision to users.

Limited resources and conflict resulting from the more containing aspects of the CPA remain obstacles for user involvement. Possible improvements include user led needs assessment, information pack provision and limiting attendance at CPA meetings.

To audit the clinical practice of seizure threshold estimation and subsequent stimulus dose adjustment in the electroconvulsive therapy (ECT) clinic. Case notes of patients who had ECT over a six-month period were audited. Results were discussed at an audit meeting and guidelines and training modified appropriately prior to the second cycle of the audit.

Initial dose titration was poor in the first period, but improved in the second. The majority of patients were insufficiently stimulated after missed seizures in both periods and stimulus doses were not being reduced following prolonged seizures.

The audit identified the need for continuing supervision of trainees in addition to clear training and guidelines.

To evaluate ultra-rapid opiate detoxification under sedation. Symptom control was analysed in the first 12 hours of detoxification in 20 patients and case notes were examined 12 weeks later for outcome.

Good symptom control was achieved, except for restlessness. At 12 weeks 25% patients were abstinent.

While long-term outcome is similar to conventional methadone detoxification, the ultra-rapid technique is safe, more acceptable to patients and more cost-effective.

The aim of the study was to assess and update the data related to the use of lamotrigine, gabapentia topiramate and tiagabine as mood stabilisers. The published trials and case reports were collated from searches of the Cochrane Collaboration, Medline and Micromedex from January 1985 to January 1999. The manufacturers were also contacted.

The search included other aspects of the usage of these anticonvulsants, such as side-effects and drug interactions.

Most of the data are in the form of anecdotal case reports and small scale open studies. The majority of the trials lack a placebo arm and do not use standard rating scales or standard diagnostic criteria. The usefulness of the results is partly limited by the short durations and small sample sizes. Furthermore, it is often unclear whether concomitant medication was altered.

Therefore, any conclusion of effectiveness requires confirmation in double-blind placebo-controlled studies to eliminate any false-positive response due to bias, placebo effects or random variability. There is also possibility of false-negative selection bias, as the early data tends to relate to a more refractory population. The use of these newer anticonvulsants as mood stabilisers is currently under investigation in a clinical trial programme.

There are no studies comparing the new anticonvulsants either with each other or with established agents. There is less evidence supporting the use of the newer anticonvulsants in bipolar disorders compared with established agents. The newer anticonvulsants should be used as third- or fourth-line agents. There is more data supporting the use of lamotrigine and gabapentin.