To describe the use of thioridazine in a population of adults with learning disabilities at the time of the warning issued by the Committee on Safety of Medicines (CSM). Also, to observe the result of discontinuation of thioridazine and to examine factors that were associated with adverse events. Retrospective case note analysis was carried out for a sample of individuals with a learning disability.

Over 50% of those on regular thioridazine experienced adverse events during or following drug withdrawal. Adverse events were significantly associated with the duration of previous thioridazine prescription. Higher drug dosage and a more severe degree of learning disability may also be factors linked to poorer outcomes.

More caution may be required when reducing or withdrawing antipsychotic medication in this patient group.

A postal survey was conducted to establish an overview of liaison psychiatry services in the south-west of England. Questionnaires were sent to all clinical directors of medicine, accident and emergency, and mental health in trusts which provide acute medical services.

Thirty-six questionnaires were returned (77%), covering 17 out of 18 trusts providing acute services. Five trusts (28%) have a comprehensive dedicated liaison psychiatry service. A further six trusts (33%) have a service for deliberate self-harm only. Many respondents were critical of what they perceived to be an inadequate service. Five trusts had introduced a service in the 12 months preceding the survey.

An unmet need for liaison psychiatry services is clearly perceived across the south-west of England.

Prescribing of venlafaxine in The South London and Maudsley NHS Trust was found to account for over 50% of the antidepressant costs, but only 15% of the prescriptions. There is evidence to suggest that higher doses of venlafaxine may be effective in treating treatment-refractory depression. We aimed to discover if higher doses of venlafaxine used in the trust were related to prior failure to respond to antidepressant treatment. Hospital in-patients being treated with venlafaxine during a 1-week period in October 2001 were identified and case notes were reviewed to determine patient demographic data and prior history of antidepressant therapy.

There were 38 patients identified as being prescribed venlafaxine (18 of whom had a primary diagnosis of depression). Twenty-five were classed as non-treatment-resistant and 13 were classed as treatment-resistant. Doses of venlafaxine were statistically significantly higher in patients considered treatment-resistant (245 mg v. 180 mg daily, P=0.03). All other recorded patient characteristics were similar.

Higher doses of venlafaxine were prescribed to patients who were retrospectively defined as treatment-refractory. Further studies should address the reasons for this prescribing practice.

The perceptions and expectations by referrers of assessments performed by a medium secure unit were examined in order to ascertain areas for possible improvement. All referrals to two teams at the North West Thames Regional Secure Unit were monitored over a 6-month period. A self-report questionnaire was sent to each referrer, in cases where an assessment and forensic report had been completed.

Assessments and forensic reports were completed (and questionnaires sent to referrers) in 63% of total referrals (32 out of 51). The response rate to the questionnaire was 81% (26 out of 32). Many referrers wanted the assessments and report to be completed in 2 weeks. Most referrers were satisfied with the quality of the report received and the majority were happy with the risk assessment.

Referrers want forensic assessments to be of a high quality and to be performed quickly. Recommendations for service development are suggested.

The use of illegal drugs is becoming increasingly common and presents particular problems in pregnancy. There is strong evidence to suggest that improvements in obstetric and neonatal outcomes can be made by attempts to treat the substance misuse problem, although this group may have limited engagement with traditional medical services. We conducted a retrospective case note review of a specialist ‘mother and baby team’ within a drug misuse treatment service to determine whether it had achieved its original service aims.

There was a high level of engagement with the service, with the majority of cases staying in contact for over 20 weeks. The average dose of methadone fell during the course of the pregnancies, and at the time of delivery, only 20 of the 80 cases (25%) still in contact with the service had urine tests that were positive for heroin. A significant number of women managed to completely detoxify from all drugs by the point of delivery, in contrast with previous studies conducted with this patient population.

This study demonstrates that the specialist service for pregnant drug users has been effective in engaging those misusing drugs in treatment, leading to significant improvements in key outcome measures.

We conducted the first systematic territory-wide survey of electroconvulsive therapy (ECT) practice and utilisation in Hong Kong. All public ECT services were evaluated with a postal questionnaire, a visit and observations of ECT administration. All private ECT practitioners were surveyed using a postal questionnaire.

Most practice areas at the public ECT services in Hong Kong complied with College guidelines. However, a few private practitioners were still using outdated ECT machines. The number of ECT courses completed in 1998 was 0.34 per 10 000 population, which was much lower than the rate of ECT use in Western countries.

We obtained basic information on ECT services in Hong Kong and on areas requiring immediate attention.

To develop an evidence-based approach that supports the improvement of front-line delivery of adult acute in-patient services. Key factors of effective organisational change were identified from the literature. These were adopted as part of an ‘evidence-based service development’ programme. This approach was used by the Health Advisory Service in a project with an NHS Trust in south east England.

Significant progress was made in improving the quality of local acute in-patient services.

Further development and evaluation of this approach should be undertaken, since it seems to offer significant opportunities to deliver real improvements in the quality of services.