A questionnaire was sent to all 55 community child and adolescent psychiatrists working in the West Midlands to examine the prescribing practices of community child psychiatrists, because most previous studies have included prescribing data from specialist (tier 4) services.

The survey had a good response rate (87%). The vast majority of child psychiatrists were prescribing stimulants and antidepressants, and over half were prescribing antipsychotics and melatonin. At least half of the consultants would consider prescribing an antipsychotic for the treatment of aggressive behaviour. One-third of consultants cited pressure on services as a reason for prescribing medication.

Community child psychiatrists were prescribing more medication than expected, which may have a considerable impact on referral rates to adult services in the future. It is concerning that the increased use of medication may be a reflection of pressure on services.

In this study we aimed to identify negative life events, especially those associated with repetition, in the background histories of patients in a 2-year prospective monitoring study of hospital-treated deliberate self-harm (DSH). Thematic analysis of the narratives recorded during assessment was used to produce general categories of life events.

In 3031 DSH episodes (n=2287 individuals), women reported more life events than men. Family and interpersonal problems were most commonly reported. Reporting a dysfunctional family of origin, a history of sexual abuse and the imprisonment of self or other were associated with repetition retrospectively and prospectively.

The background history of patients who harm themselves should be explored routinely on assessment in order to help establish risk of repetition and to determine appropriate follow-up.

A medical second opinion is an expert clinical case evaluation requested by a colleague for a patient already under specialist care. There is no literature on the provision for second opinions in psychiatric practice other than those relating to the Mental Health Act 1983, and the availability of clinics offering second opinions varies greatly from one area to another. We undertook a survey of an expert second opinion service in Leeds over the period 1988–2000 and examined the case notes of 103 referred patients, of whom 71 were included in the analysis data.

In the majority of cases diagnoses were not changed, but alternative treatment strategies were suggested. The exception was for patients with a diagnosis of personality disorder, in whom neither a new diagnosis nor alternative management was commonly suggested. Half of the assessments were completed in a single visit, but a substantial minority required further evaluation as outpatients, close follow-up or even hospital admission for detailed review.

We believe that a second opinion service offers clinicians valuable support and expertise, especially in sector psychiatry. Evidence presented suggests that further therapeutic options are available for many patients regarded as ‘difficult to treat’. In some cases this may involve a period of observation free of all psychotropic medication. As in other specialities, psychiatrists should be aware of the value of further advice for patients with particularly refractory or unusual disorders.

To identify activities that can be modified in the psychiatry out-patient clinic in order to improve the quality of services rendered. Consulting doctors obtained information on the reason for consultation and time spent by each patient over a one-month period.

Half of all the patients (50.5%) came for a repeat prescription, and 19.3% came for a repeat prescription and counselling. The mean times spent on these two activities were 5.13 (s.d.=2.5) and 7.81 (s.d.=7.51) minutes, respectively. The time spent on these activities by doctors was 47% of the total clinic time.

Clinic services should be reorganised so that doctors can use their skills in more efficient and creative ways.

The aim of this survey was to look at current practice in monitoring weight and glucose control in in-patients being prescribed antipsychotic medications. Records for 51 patients admitted with psychotic illnesses to a large teaching hospital during a 3-month interval were surveyed.

Fifty-five per cent of patients had no record of weight taken on admission to hospital. Only one patient had their weight repeated during the admission. Forty-nine per cent of patients had random blood glucose checked on admission. No fasting levels were performed.

Weight gain and hyperglycaemia associated with antipsychotic prescription are well-recognised side-effects. These results suggest that standardisation of weight measurement and blood glucose monitoring is required.

We describe the Balint case discussion group method and how it can be applied to training psychiatrists. In a group that we ran, the performance of members on a clinical task before and after a year in the group was investigated. Written responses to a case vignette were appraised blindly by psychotherapists who were also examiners for the Royal College of Psychiatrists.

There were eight members in the Balint group, which met weekly for one year. We found that members' performance on the clinical task improved significantly following the year spent in the Balint group.

A Balint group, as part of an introduction to psychotherapy for psychiatrists, may represent a step towards achieving comprehensive training that is relevant to ordinary clinical practice.