To assess and update the available data on use of ginkgo to treat dementia. A Medline search as conducted for the period January 1985 to October 2000. The search included other aspects of the usage of ginkgo, such as side-effects, mechanism of action and drug interactions.

Most of the trials using ginkgo were to treat cerebral insufficiency. Only five trials could be identified that used ginkgo to treat dementia. There are no trials comparing ginkgo to cholinesterase inhibitors such as donepezil.

Ginkgo is generally well-tolerated and appears to ease the symptoms of dementia. Although it has been suggested that the effect is comparable to donepezil, confirmation from controlled studies is required.

Three cases are described to illustrate the elective use of etomidate in electroconvulsive therapy (ECT) anaesthesia.

Use of etomidate is described in an individual who was treated with an electrical stimulus at the maximum level for the ECT machine in use; in a person who had severe side-effects with an alternative induction agent; and in a person with severe cardiac disease.

The anaesthetic drug should be tailored to the individual needs of the person being treated with ECT. Clinics should involve local anaesthetic departments in reviewing their anaesthetic practice.

The working relationship between consultant psychiatrists and crisis resolution/home treatment (CRHT) teams varies quite widely. Data from the national survey have been used to investigate the effects of consultant psychiatrist intput upon functions of the CRHT team. Logistic regression was employed to consider the effects of team size, team maturity and consultant input upon gate-keeping and fidelity to model (how many of six criteria teams' activities included).

There were statistically significant effects of size and maturity upon fidelity, and of maturity and consultant input upon gate-keeping.

The relationship between the consultant psychiatrist and other elements of the acute care pathway is an important determinant of how it functions. Depending upon how they relate to them, consultants can assist or hinder a team's capacity to fulfill their intended purposes.

We examined non-medical use (NMU) of olanzapine among adults on methadone treatment. Information was collected on patient demographics and NMU of olanzapine. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was administered to assess risk among current users of olanzapine.

Ninety-two clients participated and 30% reported lifetime history of NMU of olanzapine. Nine people reported doses of 30 mg or higher on a typical day of use, with three typically using 100 mg. The most common reasons for use were to relieve anxiety and to aid sleep, but a quarter used it to ‘get stoned’. Eleven participants (12%) reported NMU of olanzapine in the preceding month. Eight completed the ASSIST with four scoring in the high-risk zone.

Self-medication is the dominant motivator for NMU of olanzapine, but hedonic motivations also occur. A small minority show features of dependency. All doctors should be aware of the potential NMU of olanzapine, especially among patients with history of addiction.

A structured interview-based questionnaire was used to measure the number of cards and gifts received by 40 people undergoing psychiatric in-patient treatment, compared with an age- and gender-matched group of medical in-patients. The study also assessed the amount of disclosure of admission and diagnosis to family and friends in the two groups.

The psychiatric patients received about half as many cards as the medical patients (60 v. 112). Gifts to the psychiatric patients were often practical in nature and seldom included luxury items such as flowers. Disclosure of admission for mental illness (compared with the physical illness group) was significantly lower, both to family members (139 v. 193, P=0.041) and friends (74 v. 332, P=0.0001).

The stigma of mental illness is reflected in the secrecy surrounding disclosure of hospital admission and the lack of tokens of support. Clinicians should be aware of the resulting sense of isolation and shame, and the consequences for mental health in view of reduced social networks increasing the risk of future relapse rates. Reduced contact with mentally ill patients has implications for society as a whole in maintaining the status quo of stigma.

This study assesses the views and experiences of psychiatrists of the Mental Health (Care and Treatment) (Scotland) Act 2003. A postal questionnaire was sent to 340 consultant psychiatrists and specialist registrars throughout Scotland.

A response rate of 76% was achieved (n=257); 31 respondents (12%) felt patient care had improved with the newAct; 167 (65%) felt that informal patients' care had suffered; 135 (52%) did not consider that tribunals were better than the previous court system; 151 (59%) felt that the out-of-hours workload had increased.

An early indication of psychiatrists' views and experiences of the new Mental Health (Care and Treatment) (Scotland) Act 2003 is given.

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.

Capacity legislation was implemented in Scotland in 2002 under the Adults with Incapacity (Scotland) Act 2000. This questionnaire study aimed to explore the knowledge, experience and opinions of the Act among consultant psychiatrists in Scotland (n=373; response rate 64%).

The majority of respondents had attended an induction programme: 74% were confident in their assessment of capacity and 54% felt confident in their use of the Act. Awareness of the principles and code of practice was good. the administration of the Act varied between areas.

Despite good knowledge of the Act, respondents reported they were largely self-taught and would welcome further training. Administration, uptake by other medical disciplines and discrepancies between principle and practice were raised; these concerns are relevant to amendments of this legislation and to other jurisdictions.

To develop a guideline that would encourage a systematic approach for both psychiatrists and general practitioners in the provision of safe, effective and consistent management of patients who are prescribed lithium. A multi-disciplinary working group developed the guideline following literature review and consultation with lithium clinics and specialist centres nationally.

The Lothian lithium guidelines include three sections: (a) a lithium treatment plan; (b) advice for clinicians on managing lithium levels; and (c) pointers for counselling patients on lithium. The treatment plan is a key document in the guidelines which, once completed, ensures continuity of care with the transfer of patient-specific information.

This development has provided the opportunity for primary and secondary care services to work together in producing a guideline that will improve patient care and minimises risk.

Historical trends in the conceptual domains underlying articles published in psychiatric journals are indicators of major psychiatric concerns and practices. Articles in The American Journal of Psychiatry and The British Journal of Psychiatry during the periods 1947–51, 1967–71 and 2002–6 were classified into either a biomedical, psychological or social conceptual domain to determine which domains, if any, were dominant.

In The American Journal of Psychiatry one or two domains were dominant for two of the three periods. No domain was dominant in The British Journal of Psychiatry.

Examined against various scientific and social developments, American psychiatry appears more responsive to current social, scientific and commercial trends and impulses than British psychiatry.

To assess adolescents' perceptions of their psychiatric illness and the role of various demographic factors in a Pakistani setting. Adolescents with various psychiatric diagnoses were interviewed using a structured questionnaire including the Illness Perceptions Questionnaire–Revised (IPQ-R).

Fifty-two adolescents with various psychiatric illnesses were interviewed; their mean age was 12.7 years and the majority (67%) were female. Males had significantly higher scores on timeline and emotional representation (P<0.05), suggesting strongly held beliefs about chronicity of their illness and anger and worry about their condition. Adolescents' own emotional state, stress, family problems and bad luck were endorsed by participants as some of the causal factors in their mental illness.

Despite the importance of early intervention in psychiatric problems, engaging youth in the treatment process in Pakistan remains difficult. Better understanding of how adolescents perceive their psychiatric difficulties may play a significant role in developing culturally sensitive interventions and better utilisation of services.