The use of illegal drugs is becoming increasingly common and presents particular problems in pregnancy. There is strong evidence to suggest that improvements in obstetric and neonatal outcomes can be made by attempts to treat the substance misuse problem, although this group may have limited engagement with traditional medical services. We conducted a retrospective case note review of a specialist ‘mother and baby team’ within a drug misuse treatment service to determine whether it had achieved its original service aims.

There was a high level of engagement with the service, with the majority of cases staying in contact for over 20 weeks. The average dose of methadone fell during the course of the pregnancies, and at the time of delivery, only 20 of the 80 cases (25%) still in contact with the service had urine tests that were positive for heroin. A significant number of women managed to completely detoxify from all drugs by the point of delivery, in contrast with previous studies conducted with this patient population.

This study demonstrates that the specialist service for pregnant drug users has been effective in engaging those misusing drugs in treatment, leading to significant improvements in key outcome measures.

Specialist registrars (SpRs) in psychiatry spend only 3 years in this grade, with 1 day a week allocated to research. In view of this sizeable proportion of time designated for research, we undertook a postal survey of the experiences of and attitudes towards research of SpRs in developmental psychiatry.

A high proportion of respondents were involved in research at the time of the study, although half described difficulty starting and a third described difficulty taking the day. The majority of respondents believed research to be important and about three-quarters found it enjoyable.

While research remains a mandatory part of training it is important that trainers ensure that research time is protected.

The study explored the impact of National Health Service changes on the working and personal lives of psychiatrists. A questionnaire survey was carried out with psychiatrists working in the South Eastern Division of the Royal College of Psychiatrists.

The response rate was 44.9%. Changes to services have reduced stress in some areas, but increased stress in others. Over the past decade early retirement has become less popular, but psychiatrists have been more likely to self-prescribe and have suicidal thoughts.

The increasing involvement of psychiatrists in leadership may be a way to reduce adverse impacts of future changes on their working lives.

This study looked at patient aggressive behaviour on an Irish psychiatric intensive care unit, and whether it was related to diagnosis, patient's insight and symptomatology. Each aggressive incident was recorded throughout the patient's stay using the Staff-Observed Aggression Scale.

Ninety-nine individuals were admitted to the unit during the study. We recorded 82 aggressive incidents, with most occurring during the daytime and on weekdays. There was no statistical difference in BPRS scores between the aggressive and non-aggressive groups. the aggressive patient group had a lower insight score than the non-aggressive group (P < 0.05) as measured on the Schedule of the Assessment of Insight. However, when gender and verbal aggression only were included in the analysis, the difference in insight was less significant (P=0.07).

Aggression is common on a psychiatric intensive care unit. Low levels of insight in patients may increase the risk of aggression.

National clinical guidance states that patients on antipsychotics should have their metabolic profile regularly monitored. The aim of this study was to assess whether we are effectively monitoring metabolic profiles and to improve the detection, communication and intervention of metabolic abnormalities among patients on atypical antipsychotics. We describe a full audit cycle.

The audit resulted in a 24% increase in the number of patients on atypical antipsychotics being referred to the metabolic clinic. The number of abnormal results communicated to primary care showed a significant improvement of 25% (P <0.001), and ultimately the number of patients who received intervention improved by 17% (P = 0.001).

Audit feedback has been effective in changing clinical practice. The audit demonstrated the potential value of a metabolic clinic and shared care between primary and secondary practitioners for this group of high-risk patients.

Due to a concern over the low level of referrals of children to the child and adolescent psychiatry team, an audit was designed to investigate the possible causes. An audit was undertaken in which the case notes of 100 consecutive adult female admissions to acute wards in Goodmayes Hospital were screened. The case notes were screened for mention of children, any actions taken on their behalf, in addition to a number of demographic and social factors.

The findings of the audit indicate that children of psychiatrically ill mothers do not receive the attention they need, as indicated by the literature on the topic.

More detailed case history-taking by the parent's psychiatrist and closer cooperation between adult and child psychiatry departments are suggested as two methods of addressing this need.

To assess the impact in the South London and Maudsley NHS Foundation Trust of a 20-month quality improvement programme on adherence with National Institute for Health and Clinical Excellence (NICE) recommendations for the use of valproate for bipolar illness in women of childbearing potential.

Significant improvement was noted between baseline and final audit in rates of information provision (10% v. 63%, P < 0.0001), contraceptive use (15% v. 38%, P = 0.0003) and folate prescription (3% v. 35%, P < 0.0001).

Adherence to guidance can be usefully improved by a sustained intervention programme.

Clinicians are often required, by managers, to provide information that does not appear relevant to clinical practice. Rooted in compromise, an outcome-based information model that supports practice and also provides information for managers was developed. A 9–month pilot project at three sites in South-East London took place to test the feasibility of this model in real clinical settings.

Accurate data were reliably collected. Clinicians at participating sites agreed the model produced potentially useful information and, on condition that support is provided, continue to collect data voluntarily.

This is not an exclusively clinical model. However, because it also fulfils management needs there is a better chance that clinicians will get the support they need.

To explore psychiatric trainees' (senior house officers') experience of a dedicated 6-month research post.

A questionnaire survey was conducted by post or e-mail of all previous post-holders of two research posts in a large London training rotation.

Twenty of the 28 post-holders completed the questionnaire. Overall, their experiences were positive in terms of research experience, exposure to academic environment and in facilitating future career opportunities. A minority of respondents found supervision to be unsatisfactory. Dedicated research posts are a valuable training opportunity that can complement clinical experience for trainees and foster an interest in research.