Despite the Royal College of Psychiatrists' recommendation that higher specialist trainees in general adult psychiatry should use logbooks to record their training-related activities, none is currently available. We developed a logbook and conducted a postal survey of specialist registrars in general adult psychiatry in the West Midlands and Merseyside Training Schemes to elicit their perceptions of its usefulness and feasibility.

All of the 35 specialist registrars who completed the questionnaire felt that there was scope for a logbook and that this format was easy to use. Three-quarters of the respondents suggested that their training curriculum should be incorporated into the logbook and 71% felt that the use of logbooks ought to be mandatory. Despite all acknowledging the need for a logbook, only 14% were currently using one.

Logbooks would greatly help higher specialist trainees to organise (identify, record and review learning objectives) the multifaceted aspects of their training. They would also help immensely in preparing for the Record of In-Training Assessment, appraisal and revalidation. There is clearly scope for a more ‘centrally’ produced (College) logbook for specialist registrars in general adult psychiatry, as indicated by the results of this survey. For logbooks to work in practice, they need to be simple and easy to use.

In-patient psychiatric care needs urgent improvement and development. A new model of psychiatric care (triage) has been used for 6 months across an adult psychiatric service covering a London borough.

Preliminary results show that the new model has reduced bed occupancy, leading to more-efficient throughput, with positive feedback from patients and staff. Important factors contributing to these positive changes include a whole-systems approach, senior medical input 6 days a week, creative use of information technology and a highly skilled multidisciplinary team.

The introduction of the new model has resulted in a more-efficient use of beds. Further evaluation will enable us to assess the impact on other parts of the service. As with all innovations, the improvements must be sustained once the initial enthusiasm has passed.

The aim of the study was to track service consumption in adult referrals to a specialised NHS eating disorders service over a 3-year period. We examined clinical records of a year's cohort (1999) of 147 referrals (96% female) assessed from the local catchment area.

The most common diagnostic group (42.8%) presented with some form of eating disorder not otherwise specified (EDNOS). There was no significant relationship between diagnosis and service consumption, so that full syndrome eating disorders were no more labour-intensive overall than EDNOS patients. Indeed, EDNOS patients accounted for 50% of all outpatient appointments and over a half of all in-patient days.

The results suggest that those planning services for eating disorders need to take into account the substantial demand from EDNOS patients.

The aim of the survey was to establish the organisational structure and practice of specialised services for post-traumatic stress in the UK. Questionnaires were collected from 17 specialised trauma services across the UK.

Specialised trauma services use similar therapeutic programmes, but differ with respect to the characteristics of the treated clientele and organisational features. Although almost all services routinely measure outcome, some of the instruments used vary. There is no clear association between staff resources and number of patients treated.

Specialised traumatic stress services in the UK employ evidence-based treatment methods. A uniform protocol to measure outcome may help to establish a common UK-wide database on outcome of specialised treatment, and facilitate a reliable comparison between different service organisations and programmes. Organisational features should be considered to increase the efficiency of services.

The study examined the prevalence of psychiatric disorders in people with HIV/AIDS attending the AIDS Support Organisation (TASO) clinic at Mulago Hospital, Kampala, Uganda and the preparedness of AIDS counsellors to deal with mental disorders. Forty-six patients were interviewed using the Mini International Psychiatric Interview to ascertain DSM–IV diagnoses. All 15 counsellors working at the clinic were interviewed.

The total prevalence of psychiatric disorder was 82.6 (38 out of 46 patients). Depressive and anxiety disorders were common. Non-affective psychoses were present in eight patients (17.4%), bipolar affective disorder in eight (17.4%) and major depression with melancholic features in five (10.9%); 8 (13%) had current suicidal thoughts. None of the people with psychiatric disorders were receiving mental health treatment. The prevalence of disorder as estimated by the counsellors ranged from 0 to 33%. Only one counsellor had received any formal training in mental disorders and only two thought that they could deal with these if they arose. The attitudes of counsellors towards people with mental disorders were mixed, but most believed that they should be trained to provide care.

There is a need to provide additional mental health services to the TASO clinic through appropriate training of TASO counsellors to improve their awareness of psychiatric disorders, delivery of some psychological therapies and liaison with the psychiatric services at Mulago Hospital, in addition to public mental health education. The psychiatric disorders experienced by those attending the clinic might put them at greater risk of contracting HIV/AIDS.

Clozapine is an effective drug in treatment-resistant schizophrenia, but it seems to be prescribed for few patients under the age of 18 years. This study reports a survey of consultant psychiatrists working in adolescent units in the UK, looking at their use of clozapine and experience with it.

Out of 83 clinicians, 59 responded (71%). More than 40% of respondents do not use clozapine, and those who do may not always be following best practice recommendations. Reasons for not using clozapine, beliefs about its effectiveness and problems encountered in its use are described.

Clozapine may not always be made available to young people with treatment-resistant schizophrenia. There is a need for more education, guidance and debate on clozapine use in child and adolescent psychiatry.

There have been a variety of instruments developed for evaluating family functioning, but no specific measure has emerged as appropriate for routine clinical use. The Family Adaptability and Cohesion Evaluation Scale (FACES) was viewed as a useful tool for a period, but has been less popular of late. This paper looks at its use in families with two very different types of problem to assess its discriminatory ability.

Mothers with depression whose children were not showing mental health difficulties reported a very different pattern of family functioning from those whose children were showing chronic school refusal.

The FACES is capable of discriminating between different patterns of family functioning. Its ease of administration, and the information it provides, should recommend it for wider use in clinical settings.

A new medication error reporting scheme (‘Safemed’) was introduced within the East Kent NHS and Social Care Partnership Trust. All medication incidents reported using this system in the first year were analysed by the Chief Pharmacist.

Over a 12-month period a total of 66 incidents were reported through Safemed, compared with 55 incidents under the previous system. The low level of reporting made detailed statistical analysis and drawing meaningful conclusions problematic. There was a large variability in reporting between similar sites.

The low level of reporting was associated with cultural factors, in particular the failure to fully implement a ‘no blame’ culture. Until such a culture is established, reporting will remain variable and a systems approach to preventing medication errors will not be adopted, leading to significant clinical risk.

To assess the value of computed tomography (CT) in patients presenting to an old age psychiatry service over a 2-year period, and to evaluate a set of clinical prediction rules and the recommendations of the Royal College of Psychiatrists on the selection of patients for scanning. A retrospective review of the reports of 178 consecutive scans and case note reviews was carried out.

Four scan reports (2.3%) suggested potentially reversible causes (PRCs) of dementia. of these, only two showed unequivocal organic brain lesions. Both of these patients were identified by each of the prediction rules tested. There was a high incidence of small vessel disease (32.8%) and infarcts (11.9%).

CT is a low-yield investigation in terms of identifying patients with PRCs of dementia. The tested clinical prediction rules appear sensitive in detection of PRCs. CT may demonstrate unsuspected cerebrovascular disease.

A pre-/post-intervention audit of 163 case notes was conducted to assess the efficacy of printing information about the identification and treatment of the Wernicke–Korsakoff syndrome on the hospital alcohol detoxification sheet.

Parenteral thiamine was indicated in 42 of 163 patients; 26 had symptoms suggestive of Wernicke's encephalopathy and 16 were at risk. The intervention increased the chance of appropriate parenteral treatment by an odds ratio of 5.9 (95% CI 1.3–27.8). Admission to a specialist alcohol unit increased the chance of appropriate treatment by an odds ratio of 7.0 (95% CI 1.52–32.25). The mean number of doses rose from 3.08 to 4.62.

A simple intervention may lead to improved treatment of patients with Wernicke–Korsakoff syndrome.

The Health of the Nation Outcome Scale for Acquired Brain Injury (HoNOS–ABI) is a relatively new outcome measure designed to assess the neuropsychiatric sequelae of brain damage. This study investigated the interrater reliability of this scale. Fifty patients with traumatic brain injury receiving rehabilitation were each rated twice on the HoNOS–ABI, by two different raters. There were 24 raters in total.

Weighted kappa values ranged from 0.43 to 0.84 and intraclass correlation coefficients from 0.58 to 0.97 for the ten items assessed. This indicated that agreement was moderate to substantial for all items.

The scales consistently measured the items of interest across different raters. This indicates that HoNOS–ABI is a reliable outcome measure when applied by different raters in routine clinical practice.

To survey current specialist perinatal psychiatric provisions and opinion about these services in England. A brief semi-structured confidential questionnaire was circulated to the lead clinician or manager responsible for perinatal services of the 78 mental health trusts in England.

Fifty-seven trusts (73%) responded. In 26 trusts (46%), availability of either specialist in-patient facilities and/or intensive home treatment facilities were reported. In only 13 trusts (23%) was there evidence of provision of services covering both in-patient and community components. The number of mother and baby units or their equivalents has reduced in the past decade. The services were generally considered to be inadequate nationwide and opinion remains divided about the best approach for providing them.

There is a need for a recommendation of a national standard provision of perinatal services by mental health trusts.

To examine the standards of lithium monitoring in eastern Hull following the introduction of a local prescribing framework, we investigated the biochemistry records of patients currently prescribed lithium, identified from primary care computerised records. A survey of patients' knowledge about lithium therapy was also conducted.

Inadequate standards of lithium monitoring were demonstrated, with only 50% of patients having a level recorded during the preceding 3 months. Monitoring of thyroid and renal function was better, with two-thirds of patients tested in the past year. Patients' knowledge of the side-effects and risks of lithium was minimal; only 7 out of 27 patients questioned felt able to identify the signs of lithium toxicity; three-quarters of those surveyed felt they had not been given enough information about their medication.

The introduction of prescribing frameworks or other guidelines does not ensure good practice. Further actions may be needed to ensure lithium is prescribed safely, such as patient registers, monitoring cards and automatic recall systems. Education of patients and primary care staff about the safe use of psychotropic drugs needs to be an ongoing process.

The aim of the study was to compare referrals to a liaison psychiatry service and a neighbouring community mental health team (CMHT). Demographic and clinical information were compared for 100 consecutive referrals to each service.

The liaison psychiatry service had a smaller ongoing case-load and a higher referral rate than the CMHT. Larger proportions of patients referred to liaison psychiatry had comorbid physical illness (49 v. 10%) or had harmed themselves (41 v. 10%). More patients referred to the CMHT had a primary diagnosis of a mood disorder (49 v. 28%), but fewer had organic disorders.

The differences in service delivery and clinical problems referred imply that different expertise is required by those working in each service. This supports the view that community and liaison psychiatry are separate specialties, with implications for higher specialist training.

To investigate patients' views on receiving copies of letters sent by their healthcare professionals, 72 patients were asked about their willingness to receive a copy of the letter sent to their general practitioner and about preferences for the type of information to be included in such letters. We also asked what concerns, if any, they had about the process.

Three-quarters of the respondents (n=55) said they would like to receive a copy of the letter. Patients accepted the inclusion of information about their illness but were reluctant for data about their family, work and finances to be included.

Although the majority of the patients we interviewed wished to have the copy letter, many of them expressed concerns about confidentiality, the risk of distress and the cost of the process to the National Health Service. The rights of those who do not want copy letters should also be respected.

To examine the activity of the East Sussex Court Assessment and Diversion Scheme and to investigate its diagnostic formulations, recommendations and the short-term outcome of individuals referred, using a retrospective analysis of data collected over 3 years during the everyday clinical duties of scheme members.

Diversion was recommended for 858 individuals from a total of 1830 referrals. Most were referred to community services, but 131 were admitted to hospital, the majority under compulsion. The number of individuals admitted to secure hospitals has increased, and delays in admitting them have lengthened. The ethnic minority population was over-represented in referrals.

Court liaison and diversion in East Sussex successfully directs defendants with mental disorders to appropriate resources, both general and specialist, in-patient and community. The expansion of in-patient secure services needs to continue to accommodate increased demand. Reasons why ethnic minorities are over-represented in referrals require further study.

The aims of this study were to describe the characteristics of substance misuse services prescribing methadone for maintenance treatment of opioid dependence and to determine the average daily doses of methadone prescribed across England. A postal questionnaire survey of all substance misuse treatment centres in England was carried out.

A total of 298 treatment centres were identified and contacted, 212 of which responded to the survey (response rate of 71%). Of these, 157 were prescribing methadone for maintenance treatment; the majority (71%) were community-based and 125 centres had doctors attached. The most common formulation of methadone prescription was oral methadone mixture (152 centres, 97%). The mean daily dose of methadone prescribed was 47 mg. Surprisingly, 37 (24%) of the respondents felt that methadone maintenance treatment should be time-limited and 21 teams (13%) stated that patients should receive only drug substitution and no psychosocial interventions.

There is currently a move among substance misuse services towards community-based treatment. In our survey, the mean daily dose of methadone prescribed was less than the dosage recommended by the Department of Health. This suggests that specialist addiction services are continuing to underprescribe heroin substitutes. The inadequate understanding of some of the respondents of the basic principles of methadone maintenance treatment also raises concerns, and highlights the need for further training and education.

To study the association between study support and outcome in randomised controlled trials (RCTs) of psychotropic drugs, we reviewed all RCTs published in four psychiatry journals over a 5-year period. Chi-squared tests were used to analyse the association between RCT support and outcome, and logistic regression to determine which variable best predicted outcome.

A significantly higher proportion of manufacturer-supported RCTs (125/138, 91%, 95% CI 88–93) had a positive outcome than non-manufacturer-supported RCTs (39/50, 78%, 95% CI 72–84; P=0.02). Having an employee author almost guaranteed a positive outcome (56/58, 97%, 95% CI 94–99).

Outcomes of drug RCTs have a significant association with support by the manufacturer of the experimental drug. Systematic reviews and meta-analyses based on these RCTs may be biased in favour of newer drugs.