To survey forensic psychiatry teaching in UK medical schools. A questionnaire was sent to all 24 deans.

Twenty-one schools responded, 15 (71%) provided forensic psychiatry teaching. Thirteen organised one or more lectures and 13 organised visits to forensic psychiatric settings, predominantly high security hospitals, but these were usually only available to a proportion of the students in each year. Clinical placements, seminars or workshops and tutorials or supervisions were each arranged in about half of the schools. Only four schools offered special study modules (SSMs).

Forensic psychiatry teaching would benefit from further development, with additional use being made of medium secure hospital units and prisons for the purposes of clinical placements and visits. More SSMs should be organised.

Psychiatry in the UK has long-standing issues in recruiting UK-trained doctors. A key potential influence on interest in psychiatry during medical school is the clinical attachment. This narrative review investigates how the clinical experience of psychiatry affects medical students' attitudes towards the specialty.

We identified 107 studies, of which 46 were included. They showed that clinical attachments in psychiatry did result in more positive attitudes towards the specialty and increased career interest. There was inconsistent evidence on whether interest was maintained, with some studies indicating that the increase is transient. Factors which may influence attitudes include attachment setting, duration and student demographics.

The results suggest a need to actively maintain interest in psychiatry throughout medical school. Research with long-term follow-up and evaluation of schemes to maintain students' interest is needed.

On 1 November 2006, Ireland's Mental Health Act 2001 was implemented, replacing the country's Mental Treatment Act 1945. We aimed to assess the impact of this change in legislation on the number and duration of involuntary admissions. We undertook a retrospective review of all admissions to a psychiatric admissions unit from January to October 2006 (pre-implementation) and January to October 2007 (post-implementation).

There were 46 involuntary admissions in the 10-month period under study in 2006, or 33.8 per 100 000 population. There were 53 in 2007, or 39.3 per 100 000 population. This increase was not significant (z = – 0.7, P = 0.46), however involuntary admissions formed a larger proportion of all admissions under the Mental Health Act 2001 than under the Mental Treatment Act 1945 (χ2 = 4.2, P =0.04). There was no difference in the duration of involuntary admissions but under the 2001 Act, involuntary patients had longer periods of voluntary status as part of their admissions than under the 1945 Act.

The introduction of more rigorous procedures for involuntary admission did not significantly change the rate or duration of involuntary admissions in our centre. The finding that involuntary admissions included longer periods of voluntary status suggests that more care is being taken to revoke involuntary admission orders under the Mental Health Act 2001 than under the Mental Treatment Act 1945.

We questioned 141 senior house officers (SHOs) across three training schemes in order to ascertain the awareness and achievement of psychotherapy requirements as recommended by the College. A structured questionnaire was used and administered either in person or over the telephone to all SHOs. Of all the trainees surveyed, 32 were eligible for MRCPsych part II.

Only 9% of the SHOs eligible for MRCPsych part II were able to meet the requirements. Less than a third of all trainees were aware of the College guidelines.

Trainees face a number of practical problems in meeting the College guidelines. Psychotherapy training for basic specialist trainees is in need of urgent review and steps need to be taken to ensure that SHOs are gaining basic psychotherapeutic skills.

A postal survey was conducted to determine what proportion of psychiatric specialist registrars working in Scotland (n=119, excluding those specialising in psychotherapy) met the requirements for experience in psychotherapy. Since 2004, this has been a compulsory part of eligibility criteria for the MRCPsych part II examination.

Two-thirds of those surveyed responded. One-third of respondents met the Royal College of Psychiatrists' requirements for psychotherapy experience. Half the respondents reported competence in at least one modality of psychotherapy. Four-fifths of respondents were interested in gaining further experience and training, two-thirds in developing a special interest and one-quarter in dual training, in at least one modality of College psychotherapy. There was no significant association between adherence to the requirements and self-perceived competence, qualification or the wish to gain further training and experience in psychotherapy.

The majority of trainees, even those interested in psychotherapy, still fail to meet College requirements. Many trainees would appreciate an opportunity to gain greater depth of psychotherapy experience, in addition to gaining broad experience of various aspects of psychotherapy as required by the College.

To examine and attempt to improve the recording of information within psychiatric discharge summaries in an adult psychiatry department, by means of audit and feedback. Psychiatric discharge summaries from an acute adult psychiatric department were examined to determine the recording of ten selected items. Following feedback and discussion, the audit was repeated after 6 months.

Fifty-one discharge summaries were examined on the first occasion and 53 on the second. There was considerable variability in the standard of recording across the selected items, but the patterns of recording were similar at both stages. No improvement was found in the recording of information at the second audit.

Audit and feedback alone may have little effect in changing clinical practice. This study examines the experience of undertaking clinical audit from a trainee's perspective, illustrates barriers to change and highlights the possible limitations of audit as a clinical tool.

We carried out a web-based survey to establish the proportion of London psychiatry senior house officers who undertake personal psychotherapy. Demographics, training characteristics and psychotherapy experience were examined using descriptive statistics. Predictors of personal psychotherapy status were examined using logistic regression.

The majority of trainees who undertook personal psychotherapy included training as a reason for doing so. of the participants, 16% had undergone personal psychotherapy and of the remainder, 73% reported that they would consider it in the future. Ethnicity was the only predictor of psychotherapy status, with White British trainees nearly four times more likely to pursue it.

Personal psychotherapy appeared to have relevance to training from both a pastoral and a learning perspective. If training schemes wish to support this practice they will need to address difficulties trainees may face in accessing therapy. Trainees might also be encouraged to think about the effect of cultural factors on their attitudes towards psychological therapies.

The aim of the study was to investigate whether psychiatrists consider that patients with schizophrenia present a greater risk of violence than patients with other forms of mental illness. Two pairs of clinical vignettes were devised. In each pair, one contained a history of violence and one did not. One vignette was mailed to each of 2000 consultant psychiatrists in the UK. Respondents were asked to give a preferred diagnosis. Rates of diagnosis of bipolar disorder, schizoaffective disorder and schizophrenia were compared within vignette pairs.

For each pair of vignettes, the rate of diagnosis of schizophrenia was higher (33 v. 21.5%, P=0.008 and 44.4 v. 32.1%, P=0.011), and the rate of diagnosis of bipolar disorder was lower (44.2 v. 62.6%, P<0.0005 and 34.9 v. 49.3%, P=0.004), among those who received the vignette containing a history of violence.

A history of violence may lead to an increased likelihood of receiving a diagnosis of schizophrenia as opposed to bipolar affective disorder. This bias in diagnostic decision-making may affect the treatment received by a patient and may perpetuate and exacerbate the stigma associated with a diagnosis of schizophrenia.

The acute psychiatric inpatient service in Christchurch, New Zealand, recently changed from two locked and two unlocked wards to four open wards. This provided the opportunity to evaluate whether shifting to an unlocked environment was associated with higher rates of adverse events, including unauthorised absences, violent incidents and seclusion. We compared long-term adverse event data before and after ward configuration change.

Rates of unauthorised absences increased by 58% after the change in ward configuration (P = 0.005), but seclusion hours dropped by 53% (P = 0.001). A small increase in violent incidents was recorded but this was not statistically significant.

Although unauthorised absences increased, the absence of statistically significant changes for violent incidents and a reduction in seclusion hours suggest that the change to a less restrictive environment may have some positive effects.

The aim of the study was to survey strategies for dealing with patients who refuse clozapine blood tests or tablets. One hundred and twenty-five psychiatric intensive care unit consultants were sent a questionnaire.

Thirty-nine (31%) questionnaires were returned. Opinions and practices were diverse ranging from uncertainty around the legal right to enforce venepuncture, to the practice of slipping clozapine into a patient's drink without their knowledge.

There is need for an open debate of the relevant legal and ethical issues.

There have been no reports on psychiatric intensive care units (PICUs) in medium secure psychiatric facilities. Using case files, we retrospectively examined the characteristics and outcomes of 73 patients who were admitted to a PICU in a medium secure unit between 1 July 1994 and 30 April 1998.

The PICU population was predominantly male, suffering from illness and detained under Part III of the Mental Health Act, 1983. Although the mean length of stay was 75 days, the majority were ultimately transferred to less intensive nursing environments and only nine required transfer to maximum security. In 10% of cases PICU admission was owing to lack of appropriate facilities elsewhere.

Although the PICU was intended as a crisis facility for the management of challenging behaviours, its function was affected by the lack of clear admission and discharge criteria and appropriate facilities for patients with diverse mental, physical and security needs.