A tertiary assessment package was set up for the more equivocal cases of attention-deficit hyperactivity disorder (ADHD) who present with problems of inattention, impulsivity and overactivity. The structure of the three-day package was discussed, with an analysis of our experience in assessing 12 children using the pilot project. The package and Its use in clinical practice are presented.

The pilot project described can be modified into a two-day package.

Assessment of ADHD conducted in multiple settings inherently has many advantages over single clinic assessment. We suggest that such an assessment protocol can be conducted cost effectively.

An examination of the activities of a district-wide dedicated admission unit for poisoned patients in Cardiff, Wales, between 1987 and 1997. Number of admission episodes, gender, drugs taken. intent, psychiatric diagnosis and disposal were recorded.

Although the number of admission episodes almost doubled over the 10–year period, the median length of stay fell by almost half.

The results suggest that a dedicated unit is a cost-effective model for the management of poisoned patients.

To investigate whether changes in antidepressant prescribing have been associated with alteration in suicide rate for the period 1989–1996 in Northern Ireland. Data for antidepressant prescribing were obtained from a central unit, for Northern Ireland, using the defined daily dose system for each of the above years. The number of recorded cases of suicide and undetermined death were also obtained for this period, from Northern Ireland coroners.

There was no evidence of an association between suicide rate and antidepressant prescription (r2=0.019, F test=0.115, P=0.74), despite antidepressant use more than tripling over the study period.

Even substantial increases in detection and treatment of depressive Illness may not impinge on suicide rate. It Is also possible that suicide rate may be a very poor marker of the benefits of antidepressant treatment.

To investigate whether psychiatry training in North Thames met standards set by the Royal College of Psychiatrists and North Thames Deanery. Visits to individual sites to inspect the training programmes and facilities were carried out. A speciality-specific trainee survey (paper questionnaire) was carried out and results from a general trainee satisfaction survey (electronic survey units) are given.

We visited all 43 sites. The 207 psychiatry trainees completed the speciality-specific questionnaire (response rate 40%) and 2947 trainees completed the general survey (response rate 71%) of which 280 responses were from psychiatry trainees. Trainees in psychiatry expressed greater satisfaction with their training than trainees in other specialities. However, we identified deficiencies in suitability of general practitioner posts, safety issues, electroconvulsive therapy supervision, access to multi-disciplinary training and consultant supervision.

Although trainees in psychiatry were generally satisfied with their training, the educational and safety standards set by the Royal College of Psychiatrists and the North Thames Deanery were not always met.

A total of 384 incidents of violence against the person (six ‘serious' and 378 ‘mild’), by adult in-patients in general psychiatric units (GPUs) and learning disability units (LDUs) in 10 National Health Service trusts in the Anglia region, were evaluated by Interviews with staff and examination of records.

The findings, when compared with standards derived from previous recommendations, showed deficiencies in the documentation of incidents (there was no satisfactory written record of physical restraint for 97% of incidents in GPUs and 86% in LDUs), in the training of staff in ‘control and restraint’ procedures (If two or more staff were involved In physical restraint, for 3% of incidents in GPUs and 100% in LDUs, the staff had received no training within the previous 12 months) and in policies for victim support (there was no written policy that included procedures for victim support in relation to 84% of incidents in GPUs and 44% in LDUs).

Trusts should consider reviewing their policies on the prevention and management of violence, particularly in relation to staff training.

Audio-recordings were made over a period of six months of liaison–consultation meetings between general practitioners and a community mental health team in the Scottish Borders to show general trends in length of discussion and information exchange.

Meetings were predominantly supportive, with high levels of shared information, but little educational content. Some trends in discussion time are shown.

Audio-recording could form the basis for reviewing the function of liaison-consultation meetings.

This study describes the effects of teaching medical students in a maximum security psychiatric setting. A questionnaire was distributed to students (n=210) at the beginning and end of their third year.

Following the visit to the State Hospital significantly more students understood that maximum security psychiatric facilities are part of the National Health Service; that some serious offenders may require hospitalisation rather than imprisonment; that not everyone detained in such surroundings is actively violent or dangerous, or permanently detained. Twenty-three students considered forensic psychiatry to be a possible career option.

This study demonstrates that early exposure, even to such a specialised area of practice, can enhance the prospects of future recruitment. Attracting motivated, able and interested doctors is important in improving patient care.

After gaining the impression that our discharge summaries were too long for local general practitioners (GPs), we proposed to produce an abbreviated summary. We sent a questionnaire to a sample of GPs asking which aspects of the current summary were helpful.

Although many GPs considered the summary overly long, a majority considered all the items to be at least Very helpful’.

Although previous work on discharge summaries has indicated a demand for brief, focused reports it is important to establish local GP priorities before planning changes.

To investigate the impact of a video to improve the accuracy of patients' expectations of their first out-patient appointment. An intervention study was conducted in which patients watched a video before their appointment. The video provided information about the content of the consultation, the psychiatrist's role and types of treatments.

The intervention increased the accuracy of patients' expectations but had no impact on satisfaction or anxiety. The video was popular as a means of preparing patients for the consultation.

This could be offered routinely to patients attending services for the first time.

This survey was commissioned and funded by the Department of Health to examine perceptions of training by flexible trainees in higher psychiatric training. A total of 214 trainees were surveyed using a postal questionnaire.

One hundred and thirty-five questionnaires were returned (response rate 63%). In general, flexible trainees valued the opportunity to train part-time and perceived the quality of their training to be high. However, there were drawbacks such as: perceived lack of status, restricted training opportunities and a lack of part-time consultant posts at the end of training.

Flexible training plays a major role in maintaining doctors in the workforce. However, there is a need for part-time opportunities to extend beyond the training grades and into consultant posts.

All consultant psychotherapists should be sufficiently familiar with the three major branches of psychotherapy, to appropriately match therapy with their assessment of the patients' needs. This requires that specialist registrars training in psychotherapy acquire skills in psychodynamic/interpersonal, cognitive-behavioural and systems-based therapies.

While acknowledging the benefit for the trainee of being familiar with more than one model of psychotherapy the practicalities of incorporating different models in to training is likely to be problematic, at least initially, for both trainees and trainers.

Clinical implications In this article the experience of a senior registrar who completed a training in psycho-analyticpsychotherapy prior to gaining experience in cognitive-behaviour therapy is examined from the perspective of both the trainee and cognitive-behavioural trainer.

A survey of the management of all 84 restricted hospital order in-patients with schizophrenia, resident in any hospital in England and Wales, during May 1997, with an index conviction for a contact sex offence against a woman, was carried out.

Treatment concentrated upon pharmacological therapy for psychiatric symptoms. Only a small minority of patients received specific psychological therapy to address sexual offending issues, despite responsible medical officers reporting that over four-fifths of patients continued to have marked social or sexual difficulties relating to women, and that non-psychotic factors appeared to make a significant contribution to index sexual offending in about three-quarters of cases.

Many in-patients with schizophrenia who have committed sexual offences may not be receiving optimal management and more research is required to elucidate their treatment needs.