To review the clinical and managerial impact of flooding on a community mental health team (CMHT) for older adults by prospectively recording all flooding related events met by the CMHT.

Of 348 individuals known to the CMHT, 87 lived in flood affected areas. In nine patients symptoms deteriorated. There were two new referrals as a direct consequence of the flooding. Flood effects can be grouped into: new mental illness, management problems, CMHT workload, and secondary benefits.

The immediate and delayed problems caused by flooding to the elderly with mental illness and dementia include unmasking cognitive impairment and provoking exacerbations in depressive and anxiety disorders. Personal evacuation plans should be used when moving individuals with marked cognitive impairment to avoid difficulties with identification. Overcrowding of care homes used to temporarily accommodate additional residents can contribute to behavioural changes and psychological symptoms in those with pre-existing dementia.

Early intervention in psychosis services serving the 14–35 age range often receive input from psychiatrists from both child and adolescent as well as adult mental health services. Differences in staff attitudes or practices could potentially affect the experience of care that an individual with first-episode psychosis receives on the basis of their age. In order to investigate such potential variation a questionnaire-based survey was conducted targeting the relevant psychiatrists working in a large mental health trust in north-east England.

Only subtle differences in attitudes between the two staff groups were noted. However, a number of significant differences in prescribing preferences were reported.

Attitudes towards first-episode psychosis show marked variation between psychiatrists but may not be especially associated with sub-specialty. Further national guidance should be drawn up, disseminated and implemented to help ensure that service users across the age range receive the safest and most effective medications for an episode of psychotic illness, regardless of age.

To explore clinical indications for, and results of, brain imaging in general adult psychiatry. We reviewed the 100 most recent uses of brain imaging on in-patients at the Department of General Adult Psychiatry, Mater Misericordiae University Hospital, Dublin.

Patients were of a mean age of 55.3 years. the most common indications for brain scans were cognitive impairment (33%) and other neurological concerns (e.g. seizures; 30%). Overall, 47% of scans were abnormal, with ischaemia (17%) and atrophy (10%) being the most common abnormalities. Patients with abnormal scans were older than those with normal scans (mean age 61.9 and 48.7 years respectively; P<0.001).

A high proportion of brain scans demonstrate abnormalities in general adult psychiatry patients, especially among older patients.

We surveyed the usage and perceived utility of standardised risk measures in 29 forensic medium secure units (a 62% response rate).

The most common instruments were Historical Clinical Risk–20 (HCR–20) and Psychopathy Checklist – revised (PCL–R); both were rated highly for utility. the Risk Matrix 2000 (RM2000), Sex Offender Risk Appraisal Guide (SORAG) and Static-99 were the most common sex offender assessments, but the Sexual Violence Risks–20 (SVR–20) was rated more positively for its use of dynamic factors and relevance to treatment.

Most medium secure units use structured risk assessments and staff view them positively. As HCR–20 and PCL–R/PCL–SV (Psychopathy Checklist – Screening Version) are so widely used they should be the first choices considered by other services.

Self-harm among adolescent in-patients exercises all who work with them. the UK has an exceptionally high prevalence of this behaviour compared with the rest of Europe. However, in one in-patient adolescent unit, in-patient self-harm was significantly reduced. Details of our rationale and intervention are presented, together with a retrospective data analysis.

Using a range of practical and psychological interventions, the alarmingly high level of self-harm was almost completely eliminated and this level has been maintained to the present.

Our results suggest that self-harm in in-patients can be managed and reduced without adverse effects on the patients. Our methods may be applicable to other settings, although some staff may initially feel uncomfortable with such policy.

Long-term admission trends in a large specialist National Health Service (NHS) hospital were examined over a 3-year period. These were compared with three earlier 3-year periods. the medical records were examined for admission numbers, source of admissions, length of stay, legal status, reason for admission and readmission rate.

The percentage of patients admitted from home decreased over time, whereas the admissions from group homes increased threefold. Long-stay admissions decreased in the second and third periods followed by an increase in the fourth period. There was a progressive increase in formal admissions and a decrease in informal ones. There was an increase in admissions of people with psychiatric illness and a decrease in admissions because of social difficulties. the percentage of first admissions gradually increased and the percentages of readmissions gradually decreased.

People with intellectual disability are more likely to be admitted for psychiatric reasons and to be detained under the Mental Health Act than in the 1970s. There should be a much greater interaction between hospital and community services to facilitate shorter stays and early discharge. Out-of-area placements need to be taken account of while commissioning for the total need in a geographical area.

There is a lack of tools to assess the needs of older people with enduring mental illness who have ‘graduated’ from adult mental health services and little is known about this population. the Elderly Psychiatric Needs Schedule (EPNS) was developed and applied to older people with enduring mental illness in contact with the old age and general adult components of an inner-city mental health service.

The EPNS proved reliable (mean agreement 96%, mean Kappa κ=0.90). the mean number of needs identified was 7.6, of which 4.3 were unmet and 3.3 were met.

The EPNS provided a reliable method of needs assessment in this population. the authors offer the EPNS as a tool to assess service needs of older adults with functional psychiatric disorders having ‘graduated’ from adult mental health services.

A postal questionnaire was sent to Scottish consultant psychiatrists asking about their attitudes towards unilateral and bilateral electroconvulsive therapy (ECT), and the difference in effectiveness between the two ECT types that they considered clinically significant.

The response rate was 61%. of those that responded, 62% were prescribers of ECT and most (79%) favoured bilateral ECT over unilateral ECT. the outcome that they were most concerned with was remission rate: 97% believe that an absolute difference of more than 5% in remission rate would make the difference in effectiveness between the two types of ECT clinically important.

Future investigators should focus on comparative remission rates of bilateral and unilateral ECT.

A questionnaire was distributed to consultants with a special interest in electroconvulsive therapy (ECT) at clinics participating in an ECT accreditation process. This aimed to ascertain a consensus of clinical practice regarding informing patients about the treatment and assessment of memory during ECT.

The response rate was 64%. There is consensus on informing patients about the possibility of permanent memory loss. Memory is assessed before and during an ECT course by clinical interview and Mini-Mental State Examination, but rarely at long-term follow-up.

Patients need to be informed about the possibility of permanent memory loss before consenting to ECT. Clinical teams need to make greater efforts to assess memory, particularly after this treatment.

Buckinghamshire crisis and home treatment team was struggling to meet its commissioned care episodes and found itself detached from community mental health teams (CMHTs) and acute day hospitals. An operations management consultant, using ‘lean’ principles developed in industry, worked alongside staff to redesign the service.

Improvements in staff capacity and ability contributed to more care episodes and reduced ward-stay times, compensating for the impact of a ward closure. Re-examination of individuals needs through case-review led to the development of ‘patient typing’, facilitating clear care pathways according to need. Finally, two proven modalities of community-based service were fused together.

Placing value to patients, carers and referrers ahead of old demarcations and practices has enabled a more flexible and responsive service to develop and grow.

We examined the prescribing practices concerning benzodiazepine and hypnotic medications at a university teaching hospital. Retrospective data from 74 consecutively admitted in-patients were analysed.

Benzodiazepines were prescribed to 51% of individuals on a routine basis and to 66% of individuals on an ‘as required’ basis. An indication was documented for 70% of individuals prescribed benzodiazepines routinely and for 29% of patients prescribed benzodiazepines ‘as required’. Hypnotic agents were administered to 24% of patients on a routine basis and 23% of individuals on an ‘as required’ basis. An indication was documented for 39% of patients prescribed hypnotic agents routinely and 12% of patients prescribed hypnotics ‘as required’.

Benzodiazepine and hypnotic agents are frequently prescribed without any clear reason provided in the patients' medical notes or prescription card.

To investigate non-adherence to substitute opioid treatment, using a cross-sectional study design, with 630 patients from three London community drug services. Adherence was measured as the number of doses collected from the pharmacy as a proportion of the total number of doses stipulated on the prescription during a 28-day period and was further investigated through laboratory urine drug screens.

Overall, 30.5% (n= 191) of individuals failed to pick up at least one dose of medication from the pharmacy over 1 month, but only 1.6% (n= 10) missed 50% or more of their doses. Non-adherence was associated with supervised consumption, more frequent pick-up, shorter duration of treatment, younger age, a lower dose of methadone and a recent urinalysis result positive for opiates.

Treatment services need to monitor levels of adherence to treatment and develop strategies to improve it so that treatment can be optimised effectively.

Continuity of care is an important aspect of service provision. We retrospectively examined the number of changes over a 2-year period in care coordinator for new patients on enhanced care in a London borough. Deprivation score, length of hospital stay, and health and social needs were examined for association with continuity of care.

Twenty-six patients met the inclusion criteria; ten patients (39%) had a change in care coordinator. Patients having one or more changes in care coordinator were found to live in significantly more deprived council wards (P=0.004), but their needs score (P=0.863) or length of hospital stay (P=0.368) were not significantly different than in those who did not have changes in care coordinator.

Social deprivation affects relational continuity of care in community teams but the mechanism requires evaluation.

Pharmaceutical advertising material can confuse clinical and statistical significance. We used a brief questionnaire (five questions) to evaluate psychiatrists' appreciation of this difference. This approximated to the level of critical appraisal competence of the MRCPsych part 3 examination.

Of the 113 questionnaires distributed 93 were returned complete (response rate 82%). Senior trainees were significantly better than junior trainees at correctly interpreting data (mean score (maximum 5) 2.61v.2.08; P = 0.04). Consultants did less well than senior trainees, although our sample of consultant respondents was too small for significance testing.

Learning critical appraisal for the MRCPsych examination may provide psychiatrists with valuable transferable skills and prevent gaps in our knowledge being exploited by misleading study data. Psychiatrists of all grades need to maintain their research appraisal skills and should not regard the MRCPsych examination as the end of their learning.

A postal survey assessed current views of a random sample of 154 British psychiatrists on aetiological factors in depression and schizophrenia.

Genetics, biochemical abnormalities and substance misuse were considered important factors in both illnesses. Beyond that, psychiatrists varied widely in their views. Depression was viewed as a more multifactorial condition with psychological/social factors more important, whereas biological factors were considered more important in schizophrenia. Aetiological factors were thought to vary more in depression than in schizophrenia and discussing them was seen as more important in patients with depression.

Psychiatrists' attitudes are likely to influence treatment. Patients may encounter different views depending on their illness and on the particular psychiatrist's views.

A survey of UK consultants in rehabilitation psychiatry was carried out to investigate current service provision and changes over the past 3 years.

Most services had undergone multiple changes, with an overall reduction in over half and an overall expansion in a minority. the proportion with low secure provision had doubled. Around a third reported reinvestment of rehabilitation resources into other specialist in-patient and community services.

Rehabilitation services are undergoing rapid change with diversion of resources into services that may lack rehabilitation expertise. This risks an increase in independent sector referrals for in-patient rehabilitation for those with complex needs. Expansion of community services should be balanced against the need for local in-patient rehabilitation services.

To develop standards for physical health monitoring in patients on antipsychotics in a forensic environment. We reviewed recommendations for physical health checks from key publications and then agreed a consensus on what to monitor and how often.

We developed a standardised form to ensure the requisite minimum monitoring is performed when a patient is newly prescribed an antipsychotic drug or the dose is increased, when an abnormality is detected and for routine annual physical health monitoring.

We have produced a pragmatic solution to the gap between the recognised risks to physical health of individuals treated with antipsychotic medication and the need for clear, unambiguous standards of physical healthcare.

A questionnaire survey of general hospital doctors was conducted before and after a 1h training intervention. Baseline levels of knowledge and confidence regarding the use of section 5(2) of the Mental Health Act 1983 and assessment and management of incapacitated patients were determined. Following a training intervention, improvements in these areas were established.

Eighteen doctors participated. Confidence in assessing capacity and the knowledge of treatment under common law and section 5(2) were low at baseline. Improvements were seen following the training intervention, with four knowledge items relating to section 5(2) achieving statistically significant improvements.

Simple training interventions delivered by psychiatrists may be an effective way of improving the knowledge and confidence of general hospital doctors.