To ascertain attitudes, awareness, knowledge and variations in prescribing habits of psychiatrists when addressing issues of faith, culture and dietary requirements (in keeping with the General Medical Council's and the Royal College of Psychiatrists' guidelines), and how these may affect the trust in doctor–patient relations. We undertook a cross-sectional postal survey aimed at clinicians in South West Yorkshire Mental Health Trust.

We obtained 38 responses (40% of the total number of questionnaires sent out) from two mailshots. Although the majority of respondents indicated that they were aware of the presence of potentially forbidden animal-derived ingredients in medication, only half expressed the view that a discussion regarding the above should take place prior to prescribing such medication.

Diversity training combined with taking a genuine interest in patients' wishes will not only minimise ‘mistrust’ but also facilitate prescribing in a therapeutic relationship.

A cross-sectional qualitative survey was undertaken to compare the views and experiences of psychiatrists working in low- and middle-income, and high-income countries. Questionnaires were distributed to 110 psychiatrists attending the 2007 World Psychiatric Conference in Lahore, Pakistan.

Of the 110 psychiatrists from 13 countries, 81 were included in the analysis. Their views and experiences on mentoring were compared according to country of practice, age, gender, sub-specialty and grade. No significant differences were found on any of the variables studied.

Mentoring relationship, identified as an appropriate means of responding to personal and professional challenges of psychiatric practice is valued by psychiatrists regardless of the country they have had their practice in. Our findings warrant wider study.

A cross-sectional survey of patient drug prescriptions on two elderly psychiatric wards was carried out to estimate the potential of drug–drug interactions. Two standardised databases, British National Formulary (BNF; British Medical Association & Royal Pharmaceutical Society of Great Britain, 2007) and Upto Date (www.uptodate.com/), were employed.

A majority (96%) of drug prescriptions in our study could potentially cause drug–drug interactions. Most patients were on multiple drugs (on average eight drugs per patient). There was poor concordance between the two databases: BNF picked up fewer cases of potential drug–drug interactions than Upto Date (43 v. 152 instances) and they also estimated the potential for hazardousness differently.

Polypharmacy is common in elderly psychiatric patients and this increases the possibility of a drug–drug interaction. Estimating the risk of interactions depends on a sound knowledge in therapeutics and/or referring to a standardised source of information. the results of this study question the concordance of two well-referenced databases.

To gauge the acceptability of copying a business-like clinic letter for general practitioners, written by a doctor working in the Newbury Community Mental Health Team for Older Adults. Between August 2004 and March 2006 every letter written by each doctor was stored electronically. The letters contained a clear statement of the diagnosis, the active problems and a bullet-point care plan. Any concerns or reactions to the letters were documented as they were received. Between September and October 2006, 50 service user or carer recipients of the letters were sent a questionnaire, checking whether the letter met standards of clarity, helpfulness and content.

Over 20 months 427 service users and carers received a total of 731 letters. One carer asked for the letter not to be sent in future; four carers asked for details of the letter to be modified; in only one was the content of the letter to the general practitioner modified before it was sent to the service user. The questionnaire about the suitability of the clinic letter had a 90% reply rate and all respondents said the letters were clear, understandable and that their content was of no surprise to them.

This report of a successful use of a frank business-like letter copied to service users or carers should be understood in the context of the following factors: the doctor who wrote them was familiar with and confident about the clinical work and comfortable with the style of the letter; he had a good rapport with a generally well-educated population and positive support from his colleagues. With these factors in place, the direct style of the letter was well received by patients and carers.

To establish the proportion of psychiatrists in Northern Ireland who currently work part-time and the proportion of those working fulltime who wish to work part-time. A postal questionnaire was forwarded to psychiatrists and repeated 30 months later.

In 2004, only 18.3% of respondents were working part-time, and 26.8% in 2006. A great majority stated their intent was to always work part-time, the most frequent reason being to achieve work–life balance.

A significant number of staff working part-time will have implications for the staffing of the service. Policy makers must plan for the adequate provision of part-time working arrangements.

To investigate implementation of National Institute for Health and Clinical Excellence (NICE) guidelines in mental health, focusing on the schizophrenia guideline. Data analyses centred on implementation of the guideline, as well as looking at a set of markers mapped to the NICE principles of implementation and other identified clinical prerequisites. A self-report questionnaire tool was sent to senior executives at mental health trusts containing questions linked to the markers of implementation and clinical prerequisites; responses were analysed with data from the Healthcare Commission audit of implementation of the guideline to show key relationships.

Information from both data-sets (senior executive data collection and the audit) showed that implementation is patchy, with pockets of good implementation. Findings indicate that higher levels of implementation are linked to corporate commitment and leadership, as well as support from commissioners.

Implementation might be improved by corporate commitment and leadership and better support from commissioners.

We sought to determine whether new procedures recommended by the UK Department of Health in partnership with the Home Office reduced delays in transferring mentally ill prisoners to hospital. Our main outcome measure was time taken from identification of a prisoner's need for transfer to actual transfer to hospital. Waiting times for transfers that took place during 6-month periods before and after introduction of the new procedures were assessed. We also assessed adherence to medication while awaiting transfer.

There was a reduction in mean waiting time from 77 days to 53 days (24 days; 95% CI –2 to 50). Approximately 50% of patients offered medication while awaiting transfer were non-adherent.

Despite the new procedures, many individuals with acute mental illness remain untreated in prison for several months while awaiting transfer to hospital. We recommend that time limits should be specified for hospital transfers from prison comparable to norms under civil sections.

Antipsychotic prescriptions were analysed for a large sample of psychiatric in-patients and out-patients in Hong Kong. Case notes for patients receiving high doses were reviewed and compared with the most recent consensus statement issued by the Royal College of Psychiatrists.

Demographic and prescription data were obtained from 1254 in-patients and 19 986 out-patients. Antipsychotic medications were prescribed to 1129 in-patients and 7520 out-patients, with 9.2% of in-patients and 1.8% of out-patients receiving a high dose. Almost all case notes failed to record the clinical indications for high-dose prescribing or that the patient had been informed. Electrocardiograms were performed in a very small proportion of patients receiving a high dose.

Low levels of adherence to established guidelines for high-dose antipsychotic prescription were found in this study, with clinical and medico-legal implications. The results of this study highlight the need for staff education and regular audit of antipsychotic doses in the in-patient and out-patient setting.

Health promotion campaigns using current terminology have had limited success in reducing stigma to schizophrenia. Terminology and subgroups based on historical precedent, clinical experience and psychosocial research have been developed to provide an alternative to existing terminology, and the attitudes to schizophrenia and alternative terminology of a sample of medical students (n=241) were compared.

Overall attitudes were significantly less negative with the alternatives. the students were less negative about the potential for recovery in relation to all the subgroups than for schizophrenia. Concerns about dangerousness were also less prominent with the exception of the drug-related group.

Subgroups and alternative terminology should be further explored in programmes to destigmatise schizophrenia.

Confusion in an older patient on a general hospital ward requires prompt and appropriate management. To this end, evidence-based guidelines have been produced and disseminated by Gwent Healthcare NHS Trust. An audit was carried out when it became apparent that junior doctors might not be aware of the guidelines and that their availability on the wards was limited. An action plan was generated and a second audit carried out. Our aim was to establish whether the doctors' knowledge of the guidelines and their availability on wards changed as a result of our action plan and audit.

The audit consisted of a survey of general wards at the Royal Gwent Hospital and at St Woolos Hospital to assess availability of the guidelines and a questionnaire administered to a sample of junior doctors. The guidelines were available on 17% of wards; 11% of junior doctors were aware of them. Results of the audit informed implementation of an action plan. The second audit showed a limited improvement in availability (increased to 34%) and awareness (increased to 15%) of the guidelines, with no statistically significant difference.

Apparently well-thought-out action plans may produce minimal change, but unless the audit cycle is completed this fact cannot be corroborated. In generating action plans, more consideration may need to be given to the factors that influence the spread of change in healthcare systems.

To evaluate the prescribing of valproate in clozapine-treated individuals who may be at risk of seizure. We collected point-prevalent clinical characteristics and demographics of all in-patients prescribed clozapine in an acute mental health trust. Data were collected from case notes, electronic records and drug charts, and analysed against a set audit standard.

Data were collected for 81 in-patients. Of all deemed to be at risk of seizure (n=37) only 24% were prescribed valproate at a therapeutic plasma level.

The majority of patients prescribed clozapine at risk of seizures were not adequately protected from this risk. Clear guidelines are required.

Dressing in-patients in night attire during daytime is currently practised in many in-patient psychiatric units, despite the lack of evidence to support its benefit in reducing absconding or self-harm. Using a triangulation design, we investigated the prevalence of, attitudes towards and associations of this practice in an acute psychiatric in-patient setting in the Republic of Ireland.

Case-note review revealed a high prevalence of this practice (57%) and its significant association with involuntary admission. Nursing staff believed that using night attire was effective at reducing absconding and self-harm, and that only voluntary patients should retain the right to choose their clothes. Most patients interviewed were uncomfortable in night clothes and indicated that they should be entitled to choose what to wear.

Night attire is regularly used for risk-management, despite lack of evidence supporting its efficacy and negative attitudes towards it in many patients. This practice and the reasons for its implementation deserve medical documentation.

We studied the impact of an evidence-based multidisciplinary intervention to reduce six sub-optimal aspects of psychotropic prescribing, combined as a Prescribing Practice Quality (PPQ) score over a 5-year follow-up period in a community mental health service.

Sub-optimal prescribing practices were significantly reduced after 1 year and these improvements were sustained at 5-year follow-up. The PPQ scores were significantly reduced (P<0.001) in both the overall population attending at each follow-up point as well as in the ever-present population (n=163). Use of high-dose antipsychotics and thioridazine ceased entirely; use of sedative hypnotic agents was less amenable to reduction.

Multifaceted interventions can achieve sustained improvements in prescribing practices in real-world settings.

To identify psychiatric conditions that may require psychiatric treatment in individuals referred from a diabetes centre to a liaison psychiatry diabetes clinic and to examine the referral pattern and reasons for referral. the study was a prospective case-note survey over a 12-month period.

The most common reason for referral was low mood (37.5%) and the most common psychiatric diagnosis was adjustment disorder (28.6%). Most individuals were referred by diabetes specialist nurses (53.1%). the majority (85.7%) were seen by a clinical psychologist after an initial assessment by a psychiatrist.

Common mental disorders occur frequently in individuals referred to a liaison diabetes clinic, hence the importance of early diagnosis. the involvement of psychiatrists in specialist diabetes clinics is very limited and better involvement is desirable.

We checked whether psychiatric junior doctors could identify common electrocardiogram (ECG) abnormalities. Participants were directly approached at three London sites during induction or teaching programmes.

The survey had a total response rate of 65% (36/55). Psychiatry junior doctors displayed an overall success rate of 97% in detecting whether an ECG is grossly abnormal, but were much less competent in specifying exact ECG diagnoses (success rate of 41%). Accuracy rates for some diagnoses (e.g. paced rhythm) fell to as low as 11%. General practitioners performed no better than psychiatry trainees.

There is little consensus about minimum acceptable standards in medical skills such as ECG reporting in junior doctors. These competencies are generally ignored in new curriculums. Questions regarding the appropriate remit of psychiatry doctors in this area are raised and the need for more monitoring and education of these skills is queried.

Adolescents presenting with self-harm have poor adherence to community follow-up. Poor adherence is a principal obstacle to treatment delivery and is associated with poor psychosocial outcomes. Therapeutic assessment is a novel method of assessing adolescents with self-harm. We compared therapeutic assessment with assessment as usual in a pilot study of 38 adolescents referred for psychosocial assessment following self-harm.

Significantly more adolescents assessed with therapeutic assessment than with usual assessment attended the first community follow-up appointment (75% v. 40%, χ2=3.89, P < 0.05) and engaged with services (62% v. 30% χ2=4.49, P < 0.05).

Young people assessed using therapeutic assessment may be more likely to engage with community follow-up. A therapeutic intervention at the time of the initial assessment might be necessary to enable future therapeutic work.

Psychiatrists are expected to follow guidelines in relation to patients' responsibilities regarding driving. In this study we reviewed advice on driving recorded for patients discharged from hospital following an acute psychotic episode. Guidelines on appropriate advice were then sent to all medical staff looking after in-patients.

The first cycle of the audit included 48 patients. No advice was recorded. The second cycle included 70 patients. Advice was recorded for 8 patients. Six of these patients received a standard discharge letter with a prompt for ‘driving advice’.

In contrast to current guidelines, advice regarding driving is not routinely given to patients with an acute psychotic episode. A standard discharge letter with prompts on driving may improve adherence to guidelines.