The aim of this study was to describe the early treatment phase in first-episode psychosis in an area with well-established crisis resolution teams. Socio-demographic characteristics and patterns of initial treatment were investigated for all individuals with first-episode psychosis identified prospectively over a 1-year period in two London boroughs.

Over a year, 111 people presented with first-episode psychosis. Fifty-one people (46%) were initially managed in the community, with the remaining 60 (54%) admitted to in-patient units immediately. By 3 months after presentation, a total of 80 people (72%) had been admitted and 54 (49%) had been compulsorily detained under the Mental Health Act 1983. Thirty-three people were initially managed by the crisis resolution teams and 15 of these were eventually admitted.

In a catchment area in which alternatives to admission are well developed, the admission rate for first-episode psychosis was still high.

The aim of the study was to examine treatment for the initial acute phase of first-episode psychosis at the Early Psychosis Prevention and Intervention Centre. Information regarding treatment was collected from file notes for all patients (n=112). For a subsample of patients (n=68), remission of positive psychotic symptoms was assessed using standardised ratings at 3-month follow-up.

Treatment provided was largely in accordance with recommended treatment strategies. The majority (72%) of patients achieved rapid remission of positive symptoms.

Restrictive practices other than in-patient admission, such as in-patient seclusion, police transport or a community treatment order, can be minimised. The use of low-dose antipsychotic medication is an effective treatment strategy for the initial acute phase of first-episode psychosis.

The routine monitoring of blood glucose indices for all patients on atypical antipsychotics in 2004 in a rural adult psychiatric sector was examined. Pragmatic and practical standards were based on consensus expert opinion, National Institute for Clinical Excellence and prescribing guidelines.

The audit was completed on 60 atypical antipsychotic prescriptions. Testing of blood glucose prior to the initiation or change of an atypical antipsychotic was largely followed, with an overall adherence rate of 82%. However, there were large differences in testing between in-patient and community settings. Routine yearly monitoring in the community was inadequate, with an adherence rate of 63%.

There is a welcome emphasis on the physical health of those with severe and enduring mental illness. New initiatives, including prescribing guidelines, the care programme approach and primary care registers, offer the opportunity to develop consistency and coordination between primary and secondary care in the routine monitoring of psychiatric treatments and physical health in these patients.

To investigate the effectiveness of switching children with attention-deficit hyperactivity disorder (ADHD) from immediate- to sustained-release psychostimulants (Concerta XL, a novel methylphenidate hydro-chloride) and to examine factors associated with treatment success or failure. This was a retrospective study of all such children known to four clinicians in Lincolnshire, over a 2-year period. The initial response to treatment and the response to slow-release psychostimulant as judged by the clinicians were recorded. Data were analysed using the Statistical Package for the Social Sciences version 12.

Of the children who were switched (n=97) and on whom clinical judgement was available (n=92), a statistically significant number (32%) responded poorly (P<0.001). In 26 out of the 97 patients, the switching was considered as a treatment failure and they were switched back to the original immediate-release stimulants. There was no significant-difference with possible confounding variables between children who responded well and those who responded poorly after switching to sustained-release drug.

In a real-life clinical situation there is a significant failure rate when a child with ADHD is switched from an immediate- to sustained-release psychostimulant. Further studies are needed.

We assessed the appropriateness of treatments recommended by health shop staff for symptoms of mild-to-moderate depression using participant observation with ten members of staff from ten different health shops selling herbal medicinal preparations.

A wide range of treatment options were suggested by health shop staff when presented with common symptoms of depression. The majority have no firm evidence base, with the exception of St John's wort (Hypericum perforatum).

Most alternative treatments recommended by health shops for the treatment of depression have a poor evidence base. Implications for training and communication between agencies are discussed.

The study aimed to identify the correlates of aggressive behaviour in an adult acute psychiatric ward. Over a period of 9 months, all incidents of verbal and physical aggressive behaviour exhibited by in-patients were routinely assessed using the Overt Aggression Scale.

Of the 535 patients admitted during the study period, 80 (15%) were involved in a total of 124 aggressive incidents. Of these 80, 44 (55%) had a history of previous violence and 54 (68%) had a history of substance misuse. The majority of events occurred early in the hospital stay and in most cases aggression was against staff. There were significant differences between aggressive and non-aggressive patients in terms of gender and ethnicity, with the lowest rate occurring in European females.

These results reinforce clinical impressions, and empirical evidence, and allow risk assessment to be performed with greater confidence. The relevance of ethnicity (or more likely culture) highlights the difficulties of a ‘one size fits all’ approach to risk assessment.

A substantial minority of patients attending emergency departments do so with a primary mental health problem. A number will require admission to an acute psychiatric unit. There is little guidance about the best practice in terms of risk assessment and escorting of these patients. We conducted a telephone questionnaire survey of acute trusts, to identify current policies for the transfer of patients with mental illness to acute psychiatric units.

Eighty-two trusts were contacted. We could not verify the presence of any current policies. There was considerable variation in the assessment and management of risk in these clinical circumstances.

Current local service structure and transfer distance may influence the way in which risk is assessed. However, there is a need for trusts to ensure that basic standards of risk assessment are maintained for the transfer of these high-risk patients. We recommend that all emergency departments should have such policies and that liaison psychiatry is well placed to aid their development.

To establish whether psychiatrists believe that medicine should be practised according to the principles of the Hippocratic Oath, an anonymised postal questionnaire survey was conducted of all medical staff at the Caludon Centre, an 80-bed in-patient mental health unit in Coventry.

Thirty-three respondents (82.5%) believed that medicine should be practised according to the Oath. Support for the 15 separate statements derived from the Oath varied considerably.

The principles of the Oath remain an important guide to the ethical basis of medical practice for most medical staff surveyed.

The aim of the study was to assess the response to the guidance from the Committee on Safety of Medicines (CSM) on prescribing olanzapine and risperidone for older adults. Information on 96 older patients who were prescribed olanzapine or risperidone was gathered from psychiatric case notes, general practitioners and care homes. Data were gathered 10 weeks after the CSM guidance (Time 1) and again 6 months later (Time 2).

At Time 1, 71 out of 96 patients (74%) had been reviewed and 90 (94%) by Time 2. By 6 months after the guidance 34 of 52 patients with dementia (65%) and 10 of 35 patients with functional diagnoses had been withdrawn from medication; 29% (14/49) of those withdrawn from medication had significant problems associated with withdrawal. In many cases medication was continued following risk–benefit decisions taken at review and despite CSM guidance.

Guidance has prompted review of prescribing in existing patients and some re-referrals, which has increased workload. The guidance has changed the management of existing patients, but there has been a high rate of associated clinical problems and numerous patients remain on, or return to, olanzapine or risperidone.

To investigate whether patients with dementia are referred to specialist services earlier in the disease since the launch of acetylcholinesterase inhibitors and the publication of the National Institute for Clinical Excellence (NICE) guidelines for the use of these drugs. All referrals to old age psychiatry services in two 6-month periods in 1996 and 2003 were surveyed retrospectively for diagnosis, Mini-Mental State Examination (MMSE) score and use of acetylcholinesterase inhibitors.

The mean MMSE score at referral increased from 18.8 to 21.5 (P=0.0005) between 1996 and 2003. Acetylcholinesterase inhibitors were prescribed for 35% of all patients and 58% of patients that would be suitable according to NICE guidelines in the 2003 group.

The earlier referral of patients with dementia to mental health services is encouraging.

There is poorer control of hyperactivity symptoms in community clinics than research settings, and difficulty in detecting such symptoms without standardised measures. Hyperkinetic children (n=29) were evaluated at follow-up using the parental version of the Strengths and Difficulties Questionnaire (SDQ) and, independently, routine clinic reports to test the value of a parental questionnaire.

The parental SDQ identified symptoms in more patients (25, 86% v. 13, 45%), but high levels of symptoms did not necessarily imply impairment. Even clinically identified hyperactivity provoked no change in treatment.

Parental questionnaires alone are unlikely to improve clinic practice. Research is needed into what factors influence clinical decisions regarding treatment maintenance for hyperkinesis, and the adaptation of structured protocols from major research trials should be considered.

To audit whether the introduction of a self-harm pathway and protocol increases the number of psychosocial assessments. All episodes of self-harm in a defined period during 2002 (n=335) and 2004 (n=390) were reviewed before and after the introduction of a self-harm pathway and protocol. Adherence to the protocol was also investigated.

After the introduction of the self-harm pathway and protocol, the proportion of psychosocial assessments requested had risen from 57% (2002) to 85% (2004). The proportion of psychosocial assessments completed had risen from 47% to 70%. Over the 2 years, the overall number of self-harm presentations was reduced by 27%.

The introduction of a self-harm pathway and protocol through a self-harm steering group is feasible, was well accepted and increased the number of psychosocial assessments after self-harm. It may also contribute to a reduction in the number of overall presentations with self-harm to the accident and emergency department.