The management of young offenders by specialist psychiatric adolescent forensic services is currently the subject of considerable debate at the Royal College of Psychiatrists and at the Department of Health. It is important to know what has been done in dealing with this very important group of vulnerable young people. This study aims to delineate how medium secure units become involved with this group and what happens to them.

Self-injury is a major clinical problem on the women's wards at Ashworth Hospital. Ashworth Hospital is one of three special hospitals within England and Wales that provides assessment, treatment and rehabilitation for those legally detained patients under the Mental Health Act (1983) who suffer from a mental disorder and require conditions of special security because of their dangerousness. There is extensive literature on the psychological aspects of serf-injury. However, since patients with self-injury present with damage to the body, it is surprising that there is little information on the physical health care and associated resource costs of this behaviour.

A survey was undertaken at the beginning of 1995 of all the patients in the Bexley Hospital. Demographic information was compared with the findings obtained from a previous survey conducted in 1986. Results indicated that during the 9–year interval, changes had occurred in the characteristics of the population. Most markedly, the group was younger than that originally studied, and the total proportion of legally detained patients had increased. If such trends are representative of the country at large, adequate planning must be made to cater for an ever-evolving patient group.

Although the attribution of psychotic symptoms to the television is widespread, there is little literature on the subject and one might surmise that the issue is considered so mundane as not to merit further interest.

In so far as ‘reality’ is a critical problem in psychosis, television can constitute a particular source of confusion. ‘Reality’ can be fudged by this medium for us all, with editing, propaganda, and the spectrum of front line live reports, ‘real life’ re-enactments, and drama.

The aim was to find out if professions differed in their contributions to the workload of two multi-professional community mental health teams. Both teams aimed to provide community mental health care in London, targeting those with severe mental illness and using the care programme approach. Junior psychiatrists had fewer contacts than other professionals but medical staff tended to contribute more to assessments. Community mental health nurses tended to have the most contacts. Community mental health team planners should be aware of inter-professional differences when designing teams.

The aim was to examine the impression that both general practitioners and psychiatrists have a low level of awareness and knowledge of the Edinburgh Postnatal Depression Scale (EPDS), have little experience in its use, and would not feel confident in giving advice on issues arising from its use by health visitors.

In a study of a population over 13 months, ratings were made from medical records of adults who were admitted to short-stay, non-secure (acute) psychiatric beds. Of 197 patients, 126 fulfilled DSM-IV criteria for specified psychoses; 57 of the 71 remaining non-psychotic patients had a history of repeated self-harm, or threats of self-harm, and/or a substance-related disorder. Both these behaviours can be a manifestation of, and be associated with, personality disorder. It was considered that personality disorder made an important contribution to the psychopathology in the non-psychotic patients. The findings suggest a need to evaluate the alternative to in-patient care in a standard acute unit for such patients.

There is currently concern that junior psychiatrists lack adequate skill in cardiopulmonary resuscitation. However, little attention has been given to the equally important issues of nurse training, organisation and the provision of equipment and drugs which are appropriate to psychiatric wards. This paper describes the work of the Leicestershire Mental Health Services Resuscitation Committee and makes suggestions as to how these problems may be approached.

This study surveys the extent of substance misuse behaviour among secondary students in Hong Kong. One-fifth of the sample were misusing substances themselves and one-quarter had friends misusing substances. On seeking help regarding substance misuse, two-thirds would see the school social worker; the second preferred helper was a friend.

Recent advances in knowledge about effective administration of electroconvulsive therapy (ECT) has placed great emphasis on the importance of good training and supervision of those administering it. The American Psychiatric Associaton requires that doctors be specifically accredited before they are allowed to give ECT. In England and Wales training is much more informal and ECT is often given by junior doctors. Doctors rostered to administer ECT in Wales and in two areas of England were surveyed as part of the College's third audit of ECT. About two-thirds of respondents were at senior house officer level. The training in ECT appeared of variable quality and one-half had not been supervised by an experienced psychiatrist on the first occasion they administered ECT. Responses to exam-type questions revealed that 45% lacked knowledge about one or more basic issue related to effective administration of ECT.

An audit of antipsychotic prescribing was carried out on community and in-patient samples. A novel method of expressing total daily antipsychotic dose as a percentage of the British National Formulary maximum recommended dose was used. Of 226 patients who had been prescribed antipsychotics, 16 (7%) were found to be on high closes. Their medical notes were examined to ascertain whether the Royal College of Psychiatrists guidelines were being followed. Recommendations on ways in which practice could be improved were made and a re-audit was carried out. The number of patients receiving high doses fell to 6 (3%) out of 206.

A survey of the current practice of lithium monitoring in a general hospital and the general practices it serves revealed erratic and infrequent assessments of serum lithium levels and also of renal and thyroid function. General practitioners, who in this study monitor approximately a third of the patients on lithium, performed worse than psychiatrists, but in neither case was there cause for complacency.

“Prince was far too stressed out to fly says royal shrink … Bungling Prince Charles was lashed by a top psychiatrist last night” (Airs, 1994). This colourful fragment from a national tabloid illustrates one of the less savoury aspects of the increasing visibility of psychiatry in the media. The College Public Education Committee (PEC) was established in 1988 and has monitored press references to the College. In the three years prior to its establishment, it was able to find only seven press references to the College. A more recent survey, from September 1992–1993, found 736 such references (D. Hart, Royal College of Psychiatrists, personal communication). This dramatic increase has been partly due to the increasing politicisation of health care in general. However, a significant role has been played by the PEC. It has established an efficient machine which not only disseminates information from the College to the media, but also responds to inquiries from the media. On the whole, the results of this sort of activity are beneficial, the main complication being that of misrepresentation. We tend to be painfully aware of the dubious practices of the media, in particular the iniquities of the tabloid press. However, we also need to consider the possible ethical blunders that we may commit. The whole enterprise of speaking or writing about psychiatry in the public arena has generated several areas of ethical concern.

Maurice Ravel (1875–1937), a musician of the highest order, died in a state of dementia. A genius of orchestration, a successful experimenter in musical forms and styles; he was at his best when given to composing small-scale constructions. His musical miniatures combine an extraordinary expressiveness with an unparalleled, almost mechanical precision. The latter quality provoked Stravinsky into calling him a “Swiss clock-maker of music”.

Literature searching has been revolutionised by the desktop computer. Today it is almost inconceivable to be without the tools to efficiently and comprehensively examine the medical literature. However, as this biomedical literature grows ever more vast, researchers and clinicians need to know which of the many biomedical and psychiatric databases will best cover their particular area of interest. No databases can cover everything. It is necessary to select the most appropriate source of information for the task at hand and for a literature review this will usually entail the use of multiple methods of data collection. In this brief review databases of particular interest to psychiatrists are discussed.

Changes in the organisation and delivery of psychiatric services are likely to increase the stigma of mental illness, reduce the role of the psychiatrist, and inhibit recruitment of the best medical students. The value of close integration with the district general hospital and medical school is stressed. The future of psychiatry will be in doubt if this is ignored.