High rates of metabolic syndrome exist among patients on clozapine. Monitoring its parameters facilitates interventions which may alleviate negative health consequences. We completed an audit of the monitoring of the parameters of metabolic syndrome in patients on clozapine. The results were compared with the Maudsley Guidelines for monitoring in patients on any antipsychotic medication.

Initial audit showed high overall rates of concordance with guidelines for the frequency of measurement of blood pressure (91.8%), but much lower rates for measuring fasting blood glucose (43.2%) and lipid profile (52.7%), and no record of analysis of waist circumference. This prompted development of a formal protocol for measuring parameters. Repeat audit after 1 year showed marked improvement in rates of measurement.

Implementation of relatively straightforward measures, such as the introduction of a one-page form on which to record parameters, can lead to a much improved rate of monitoring for metabolic syndrome. This should in turn prompt therapeutic interventions, which are discussed.

To evaluate ultra-rapid opiate detoxification under sedation. Symptom control was analysed in the first 12 hours of detoxification in 20 patients and case notes were examined 12 weeks later for outcome.

Good symptom control was achieved, except for restlessness. At 12 weeks 25% patients were abstinent.

While long-term outcome is similar to conventional methadone detoxification, the ultra-rapid technique is safe, more acceptable to patients and more cost-effective.

A repetition after 5 years of a prospective case note audit, looking at the impact of a recently established deliberate self-harm (DSH) assessment team on the quality of DSH assessments at Kettering general hospital.

Aspecialist DSH team achieved improvement in the quality of psychiatric assessments for the majority of patients who harmed themselves. Assessments of mental state by accident and emergency (A & E) and medical staff before referral to the psychiatric team remain problematic.

Setting up aspecialist team to assess patients who harm themselves can improve the quality of the psychiatric care they receive, but emphasis must still be placed on an adequate assessment of mental state by medical and nursing staff in A&E and on medical wards.

Most medical diagnoses are made from the physical history alone. In the psychiatric literature, physical assessment usually focuses on examination rather than history. We aimed to ascertain the relative importance that trainee psychiatrists attach to the physical history and examination, and to investigate their actual method of physical assessment. The relative weight that trainees attach to physical history and examination was assessed with a postal questionnaire. Their actual practice was evaluated by reviewing a selection of case notes from patients under their care.

Trainees weighted the physical examination as more important than the history in theoretical terms (P=0.02). They also indicated that they attached more importance to examination in their own practice (P=0.03). On review of the case notes, 34 (71%) of inpatients had been physically examined, but only one (2%) had evidence of a physical history.

It appears that many psychiatric trainees do not adhere to the basic medical principle of taking a physical history on which to base a physical examination. ‘Blind’ examinations are unlikely to yield medical diagnoses. These findings have implications for our patients' health and psychiatric training.

This study used data collected to describe the activity, case-load characteristics and outcome measures for all patients seen during a 6-year period.

The service reviewed 2153 patients over 6 years with referral rates and case-load characteristics comparable to those described in a previous study period. The team saw 82% of patients on the day they were referred. Data and outcome measures collected showed significant complexity in the cases seen and statistically significant improvement in Health of the Nation Outcome Scales (HoNOS) scores following service input.

The outcome measures used were limited, but the study supports the need for specialist liaison psychiatry for older adults (LPOA) services in the general hospital. The Framework of Outcome Measures – Liaison Psychiatry has now been introduced, but it remains unclear how valid this is in LPOA. It is of note that cost-effectiveness secondary to service input and training activities are not adequately monitored.

None.

The study aimed to determine whether medical students who participated in a student psychotherapy scheme aimed at helping them learn about the doctor-patient relationship were more likely to choose psychiatry as a career than a control group who did not participate. One hundred and ninety-eight medical students who participated in the University College and Middlesex School of Medicine (UCMSM) Psychotherapy Scheme between 1982 and 1992, and 200 randomly selected students of the same period who did not, were sent a questionnaire asking about career choice.

Seventy-seven of 163 participants in the scheme who sent back the questionnaire had not thought about doing psychiatry before entering the scheme. Of these, 11 became psychiatrists (14.3%), compared with only two (1.6%) of the 128 controls (of 152 respondents) who had not considered psychiatry as a career at the same stage. This difference is highly significant (P<0.001). Many of the participants, including those who did not specialise in psychiatry, emphasised how the scheme had helped them understand the doctor-patient relationship.

Participating in the Student Psychotherapy Scheme encouraged medical students to choose psychiatry as a career. This knowledge is important, particularly in view of the current recruitment crisis in psychiatry.

Religion and spirituality are very important personal aspects of many people's lives. Little work has looked at the beliefs of mental health professionals and how they reconcile or benefit from the potential differences of religious faith and evidence-based mental health practice. This study used semi-structured interviews to qualitatively explore how professionals from different occupations and faiths conceptualise the relationship between their beliefs and their work.

The commonly cited ‘conflict’ of science and religion was noted, as was the personal support that faith provides for many people. Participants felt their beliefs made them better at their job, not only by reconciling differences from the two paradigms but also by allowing them to recognise compatible attributes of seeking meaning to subjective experience; this had positively influenced their choice of career in mental health. A desire for ongoing opportunity to express and discuss this interface was strongly expressed, but with concern about how this would occur and be perceived.

There is a lack of qualitative research on the religious beliefs of mental health staff. In the UK generally, the role of faith in public life is a strongly debated topic in the context of an increasingly secular and yet multicultural and multi-faith society. Our data suggest that professionals' beliefs positively influence their choice of career in mental health and make them feel better equipped to undertake their roles and provide good-quality patient care. There is an expressed need for further opportunities for staff to discuss their beliefs – or lack thereof – and to consider the individual impact of beliefs on their professional life.