To investigate how much reliance on suicide verdicts underestimates probable suicides. All unnatural deaths of those 8–18 years of age in West Yorkshire during a 6-year period were identified from the death register. Deaths which had verdicts other than killed him- or herself and were not obviously accidental were reviewed by a panel of three consultant child and adolescent psychiatrists to determine whether they were probable suicides.

Of 40 deaths reviewed by the panel, 13 were identified as probable suicides, of which 6 had an open verdict, 6 were death by self-hanging classified as misadventure and 1 was an overdose with a verdict of accidental death. These 13 deaths and the 7 with a coroner's verdict of suicide gave a total of 20 probable suicides.

Suicide statistics and targets need to take into account the fact that by current methods a significant proportion of suicides by adolescents will not be included in official figures. This underestimation would have been 65% if only suicides were identified and 35% when open verdicts were combined with suicides. Underestimating the youth suicide rate has consequences for the priority and resources allocated to preventing these deaths, and suicide deaths that are not recognised as such will not be included in relevant research and audit.

The association in the media of mental illness with violence is well established. This study looks at whether there are differences in the portrayal of schizophrenia in the local newspapers of Nottingham, an area with a high crime rate and Dorset, an area with a low crime rate.

We analysed 98 newspaper articles, 55 from Nottingham and 43 from Dorset, and found no statistically significant difference in the portrayal of schizophrenia. Overall, 36.1% of articles were negative in tone, 56.7% were neutral and 7.2% were positive. In 6 of the 98 articles (6.1%) a person with schizophrenia or their carer was interviewed. These articles were either positive or neutral in tone. Schizophrenia has entered the language as a metaphor.

Local levels of crime do not appear to influence the portrayal of schizophrenia in local newspapers. Associations with dangerousness continue to predominate and the lay public continues to receive a distorted image of people living with schizophrenia. More interviews with patients and carers might help to address this imbalance. It is important to explore what the word schizophrenia means to patients and carers.

We present two patients who developed refeeding syndrome following admission to a general psychiatry ward. The practical implications of assessing and managing medical consequences in patients with mental illness who start refeeding after a period of starvation are discussed.

Patients presented with overlapping clinical manifestations of mental illness and refeeding syndrome that were difficult to recognise and manage.

Awareness of refeeding syndrome in patients with mental illness may prevent fatal physical complications.

To investigate patients' subjective attitudes to electroconvulsive therapy (ECT) a questionnaire was posted to 89 consecutive patients who had received treatment in an ECT department.

Fifty-one responses were obtained (57%). Results indicated a high satisfaction with the department and the treatment itself; 44 respondents would or might have ECT again and 35 reported at least a modest improvement with ECT. However, a high rate (60%) of subjective cognitive impairment was reported.

Electroconvulsive therapy can be an acceptable treatment option for patients when administered in an accredited clinic. More research is urgently required to investigate the exact nature of ECT-associated cognitive impairment, in terms of functional deficits, severity and practical importance to patients' lives.

This paper describes the development and initial audit of a protocol for the assessment of young people up to the age of 18 years who presented to the accident and emergency department (A&E) with self-harm. A key part of the project was education and training.

Regular training of senior house officers (SHOs) in A&E may have contributed to an increase in young people being admitted to a bed for proper assessment (as per the protocol), but psychosocial assessments undertaken by SHOs in A&E were still only partial, and there was no apparent use of the mental state examination.

Child and adolescent mental health services have an important role to play in liaising with local A&E departments in training of junior staff in psychosocial assessment and the use of the mental state examination. This is especially relevant in the light of the new training requirements of the foundation years.

To find out why consultant psychiatrists chose psychiatry as a career. A questionnaire was developed and posted to 87 consultant psychiatrists in substantive posts within a London psychiatric training scheme.

The survey had a response rate of 83% (72 out of 87). The majority of consultants (n=40) chose psychiatry as a career after leaving medical school. The most important reasons cited were empathy with the patient group (36.1%), the interface of psychiatry with the neurosciences (25%), the better working conditions expected in psychiatry (20.8%) and medical school teaching of the subject (19.4%).

The study highlights the need for recruitment efforts after medical school. The findings also reflect the lasting influence of medical school exposure to psychiatry. Interventions for improving recruitment in psychiatry are suggested. The under-recruitment of British medical graduates is masked by overseas recruitment into the specialty.