To determine the pattern of psychotropic prescribing in a group of people with psychosis who were living in the community under community mental health team (CMHT) care. Case-note entries over the previous 12 months were examined.

Only a third of individuals were on one psychotropic medication. Atypical antipsychotics were prescribed to 80.6%. Polypharmacy was common. A third of people were taking three or more psychotropic drugs and 13.7% were on high-dose regimes, mostly involving two atypical antipsychotics.

The use of atypicals has not eliminated polypharmacy or high-dose antipsychotic regimes. Clinicians need to be aware of this long-standing problem.

As part of the total experience of hospital admission, it is important to ensure that ward rounds are efficient and acceptable to patients. Self-completed questionnaires relating to the conduct of the ward round were given to a consecutive series of 100 in-patients admitted to four psychiatric wards serving one half of the population of Cornwall.

Twenty-two patients disliked being seen in their own bedrooms, 54 disliked large ward rounds and three-quarters liked having an exact appointment time. There was a group of patients who felt particularly anxious before or during the ward round.

It is important to reconsider the conduct of the ward round, and in so doing to balance the preferences of the patient with the needs of the multidisciplinary team.

To examine the prevalence of head shop drug usage in individuals attending a range of adult mental health services. We examined the effect of head shop drug usage on the mental state of individuals with a range of mental health disorders. Clinical data were obtained from 608 consecutively reviewed individuals attending adult mental health services in relation to their use of head shop and psychoactive drugs and the putative effects of head shop drugs on their mental state.

The prevalence of head shop drug use was 13% (n= 78), with a higher prevalence of usage noted in individuals younger than 35 years of age (25%). A large proportion of individuals (n= 41, 54%) reported adverse effects of these agents on their mental state, with psychotic symptoms being the most prevalent.

Head shop drug usage was associated with a reported deleterious effect on mental state, which was particularly evident for individuals with a history of psychosis.

There is considerable confusion at present among clinicians as regards the appropriateness of prescribing off-licence. Because of the nature of the registration process it is likely that a considerable proportion of prescribing will always be off-licence. This paper seeks to clarify when it is appropriate to prescribe off-licence. We convened a workshop on behalf of the British Association for Psychopharmacology involving clinicians and regulators from a variety of countries to explore this issue both generally and for specific childhood and learning disability clinical situations. Recent statements from the defence unions and consumer groups were also scrutinised.

Across senior clinicians and regulators from a number of European countries and North America there is a consensus that prescribing off-licence is a necessary part of the art of medicine.

Current advice to clinicians on the issue of off-licence prescribing can sometimes overemphasise the hazards and neglect the benefits that may stem from appropriate off-licence prescribing. Good prescribing involves specifying treatment goals and monitoring outcomes and it is more important to share this with the patient than it is to communicate the licensed status of the drug being prescribed.

A positive therapeutic relationship is essential to psychiatry and should take into account patients' preferences. Preferences of 133 community care patients were surveyed regarding dress and forms of address of six professions. Participants' sex, age, ethnicity and diagnosis were recorded.

Ninety-eight per cent of participants expressed a preference. While most preferred to be called ‘patients' by general practitioners (75%) and psychiatrists (67%), there was no statistically significant difference in preference for the term ‘patient’ or ‘client’ when used by community psychiatric nurses, occupational therapists, psychologists or social workers. Participants over the age of 40 preferred the term ‘client’. Asymmetrical relationships were preferred with general practitioners and psychiatrists, evidenced by a preference to be addressed by first name (71% and 68%, respectively), to address the professional by title (81% and 80%, respectively), and the professional to be ‘smartly’ dressed (67% and 66%, respectively).

A more differentiated approach may be suggested by taking professional background and some demographic characteristics into consideration.

Service utilisation and clinical outcomes of a newly developed specialist primary–secondary care liaison clinic for patients with medically unexplained symptoms (MUS) were evaluated in a cross-sectional and feasibility pilot study. The impact of body-oriented psychological therapy (BOPT) was explored in a small cohort of patients with an identified somatoform disorder.

Of 147 consecutive referrals, 113 patients engaged with the assessment process. Of patients with MUS, 42% (n= 45) had a primary diagnosis of somatoform disorder, 36% (n= 38) depressive disorder, and depressive symptoms (even subsyndromal) mediated the effect of somatic symptoms. A marked variation of presenting complaints and service utilisation across ethnic groups was noted. A significant reduction in somatic symptom levels and service utilisation was achieved for patients undergoing BOPT.

A high proportion of patients with MUS have undiagnosed and therefore untreated mental disorders. New and locally derived collaborative care models of active engagement in primary care settings are required. Patients with somatoform disorder may benefit from BOPT; this requires further evaluation in adequately powered clinical trials.

The aim of the study was to examine the association between the assessment of need by staff and by severely mentally ill patients using the Camberwell Assessment of Need in a semi-rural setting (Maidstone, n=50) and an inner-city area (Camberwell, n=127). Staff and patients were interviewed separately. We specifically examined differences in the total number of needs between Camberwell and Maidstone, differences in the number of unmet needs and differences in the level of agreement between staff and service users.

Patients in Maidstone had fewer needs than those in Camberwell according to both staff (4.9 v. 5.8) and patients (4.2 v. 6.3), fewer unmet needs rated (staff, 1.1 v. 1.5; patients, 1.0 v. 1.9) and a greater level of concordance between staff and patients.

The needs of severely mentally ill patients were greater in the inner-city area compared with the semi-rural one. The fact that agreement between staff and service users was less in the inner-city area also suggests that more stable staff–patient relationships existed in the rural area.

To develop a simple, pragmatic typology to characterise the nature of liaison interventions delivered by a liaison service in a National Health Service setting. We carried out a retrospective electronic case-note review of referrals to a ward-based liaison psychiatry service.

Three hundred and forty-four patients were referred to the service over a 12-month period. Ten different types of liaison interventions were identified, with the most common interventions being diagnosis (112 patients, 32.6%), medication management (57 patients, 16.6%), risk assessment and treatment (56 patients, 16.3% each). Mental Health Act work accounted for the greatest number of contacts per patient (median 7).

There are inherent limitations in any single-site observational study, as site-specific results cannot be generalised to other liaison services. The intervention categories we developed, however, are easy to use and will provide a way of comparing and benchmarking the range of interventions delivered by different liaison psychiatry services.

Caring for patients with personality disorder is one of the biggest challenges in psychiatric work. We investigated whether mentalisation-based treatment skills (MBT-S) teaching improves clinicians' understanding of mentalising and attitudes towards personality disorder. Self-report questionnaires (Knowledge and Application of MBT (KAMQ) and Attitudes to Personality Disorder (APDQ)) were completed at baseline and after a 2-day MBT-S workshop.

Ninety-two healthcare professionals completed questionnaires before and after training. The mean within-participant increase in scores from baseline to end-of-programme was 11.6 points (95% CI 10.0–13.3) for the KAMQ and 4.0 points (1.8–6.2) for the APDQ.

MBT-S is a short intervention that is effective in improving clinicians' knowledge of personality disorder and mentalisation. That attitudes to personality disorder improved overall is encouraging in relation to the possibility of deeper learning in staff and, ultimately, improved care for patients with personality disorder.

None.

A naturalistic study was conducted to examine the outcome on self-report and observer-rated measures in patients with severe, chronic, resistant obsessive–compulsive disorder (OCD) admitted to a specialised in-patient unit.

Twenty-six patients were admitted over the study period. The mean age of all patients was 37 years (s.d.=13.8, range 18–61 years) and they had a mean duration of OCD of 18.4 years (s.d.=10.9, range 4–40 years). Instruments measuring severity demonstrated a 37–67% reduction in obsessive–compulsive symptoms and a 64% reduction in depressive symptoms after an average of almost 15 weeks in hospital.

This study demonstrates that specialised in-patient care can benefit a small group of severely ill patients with OCD who fail to respond to treatment in primary and secondary care.

We aimed to assess the contents and tone of articles on mental health care in the UK print media by comparing them with reporting in the USA and Australia. Two broadsheets from each country were analysed using the Internet for a random 4 months over a 1-year period. The number of articles, their content and the views expressed in them were identified and compared.

A total of 118 articles on mental health care issues were found. The predominant tone of the articles in all three countries was negative, though there were slightly more positive articles in the USA and Australian media. Positive articles highlighted in the UK media covered mostly medical conferences and research findings.

Efforts to achieve a more positive attitude towards people with mental illnesses in the public, such as anti-stigma campaigns, operate against a background of predominantly negative coverage of mental health care issues in broadsheets. The coverage in the UK may tend to be even less positive than in the USA and Australia. Medical conferences and research findings can, however, be used to promote positive views of mental health care in the media.