Surveys suggest that UK drug services under-prescribe methadone to opiate-dependent patients. This study investigated methadone prescribing for 169 patients on long-term methadone at a specialist drug service.

The mean methadone dose for patients on maintenance was 65.8 mg, and 67.7% were taking 50 mg or more. Mean doses in relation to methadone formulation varied substantially: mixture 57.4 mg, tablets 81.8 mg and ampoules 113.0 mg. These figures are higher than those reported from national surveys. The proportion of urine screens positive for illicit opiates was inversely related both to methadone dose and length of time in treatment.

This survey shows the levels of methadone prescribing at an inner-city drug service and gives support to the effectiveness of high-dose methadone maintenance.

To describe the use of thioridazine in a population of adults with learning disabilities at the time of the warning issued by the Committee on Safety of Medicines (CSM). Also, to observe the result of discontinuation of thioridazine and to examine factors that were associated with adverse events. Retrospective case note analysis was carried out for a sample of individuals with a learning disability.

Over 50% of those on regular thioridazine experienced adverse events during or following drug withdrawal. Adverse events were significantly associated with the duration of previous thioridazine prescription. Higher drug dosage and a more severe degree of learning disability may also be factors linked to poorer outcomes.

More caution may be required when reducing or withdrawing antipsychotic medication in this patient group.

We undertook a retrospective case-note review of three cohorts of mental health admissions to determine the extent to which patient and service characteristics changed between 1988 and 1998. Changes in clinical admission thresholds were investigated by a psychiatrists' review of handwritten medical admission assessments.

Patients admitted in 1998 were demographically less stable and clinically more complex than those admitted 10 years earlier. Clinical admission thresholds remained consistent.

Our findings suggest that the perceived increase in pressure on psychiatric services over this period was a response to a change in population need. This study highlights important questions about the clinical decision-making process leading to use of alternatives to admission and the appropriateness of acute admissions.

A questionnaire was sent to all 55 community child and adolescent psychiatrists working in the West Midlands to examine the prescribing practices of community child psychiatrists, because most previous studies have included prescribing data from specialist (tier 4) services.

The survey had a good response rate (87%). The vast majority of child psychiatrists were prescribing stimulants and antidepressants, and over half were prescribing antipsychotics and melatonin. At least half of the consultants would consider prescribing an antipsychotic for the treatment of aggressive behaviour. One-third of consultants cited pressure on services as a reason for prescribing medication.

Community child psychiatrists were prescribing more medication than expected, which may have a considerable impact on referral rates to adult services in the future. It is concerning that the increased use of medication may be a reflection of pressure on services.

This study aimed to examine in-patient child and adolescent consultant psychiatrists' knowledge of and attitude to the Mental Health Act 1983 (MHA), the Children Act 1989 and issues around consent. A questionnaire form was sent to all in-patient consultants in England and Wales.

The consultants who responded (n=51, 67%) reported a desire for more training in legal issues. Knowledge of the MHA was better than for the Children Act 1989; those who used the MHA at least once every 6 months scored more correct answers to questions about the MHA than did those who used it less frequently or never.

Although the study indicates specific gaps in knowledge, the main message is that training should consider the legal framework as a whole, with an emphasis on practical issues about its application in the in-patient setting.

The Department of Health would like to see serious prescribing errors reduced by 40% by 2005. Little is currently known about prescribing errors made by psychiatrists. The aim of this study was to describe prescribing errors within psychiatry by analysing interventions made by pharmacists. Members of the SouthEast Thames Psychiatric Pharmacists' Network were asked to record details of prescribing errors made in their trusts during the month of May 2002.

Five hundred and seventy-nine errors were reported during the study period. The majority of errors were due to clerical oversights or failure to apply clinical knowledge. In 63 cases (11%), the error could have resulted in a serious outcome.

Prescribing errors are a daily occurrence in Mental HealthTrusts, and a potentially serious error is likely to occur on a weekly basis in an average trust. Steps need to be taken to minimise the chances of errors occurring.

In order to assess the current provision for patients who misuse opiates in primary care, the discrepancy between this, and government expectations and the resources required to bridge this gap, a purpose-designed questionnaire based on the Department of Health guidelines was distributed to all general practitioners (GPs) in Solihull and Warwickshire (n=379). Data were analysed with the Chi-squared, Fisher's exact, Mann–Whitney U and Kruskal–Wallis tests, using the computer software SPSS version 10.

Replies were received from 205 GPs, representing 77.2% of the practices. Only 12 GPs (6%) provided all four key services studied and 71 (34%) provided none of these services. One hundred and six GPs (51.7%) had read the guidelines. Of these, 51 (49%) were not willing to change their practice. Forty-one (39.4%) were prepared to change their practice, but only with additional resources. The main resources identified as necessary were shared care and training.

There is a huge gap between current provision and government expectations, which may be unrealistic. If this gap is to be bridged, then resources should be targeted to shared care and training for GPs.

We aimed to examine reasons for initiating and continuing the prescription of combined antipsychotics. A structured interview was carried out with the responsible medical officers for 40 ‘difficult-to-manage’ tertiary referral patients with schizophrenia who were regularly treated with two or more antipsychotics.

Lack of efficacy of monotherapy was the main reason for initiating and continuing combined antipsychotics. Other reasons for continuing combined antipsychotics included not wishing to change medication as the patient was reasonably well, and safety considerations. Perceived benefits of combined antipsychotics included fewer positive symptoms and less disturbed behaviour.

‘Difficult-to-manage’ and forensic treatment-resistant patients with schizophrenia pose a particular therapeutic challenge. Use of combined antipsychotics, although not evidence-based, is perceived by some psychiatrists as beneficial when other options have failed.

An emergency response service (ERS) was introduced to streamline the assessment of individuals presenting in a crisis in one sector of a large provincial city. Data on service activity, clinical details and outcome were recorded on consecutive referrals to the service over the first 6 months of operation, and all patients were offered the opportunity to complete the Client Satisfaction Questionnaire.

Seventy-five per cent of those referred accepted the offer of assessment, and the majority were seen in their own home within 2 hours. One in ten individuals were not offered any further mental health input and 17% were hospitalised. The number of admissions via primary care fell by 60% after the introduction of this service. However, at its peak of activity the service received an average of only two referrals per day and three each weekend. Only 30% of referrals were received outside of normal office hours. Service users and general practitioners were found to be more satisfied with the service than the staff that provided it.

The introduction of the ERS led to a faster, more consistent process of assessment of crisis referrals and assessment undertakings in the community, and appeared to increase the use of alternative treatments for individuals in crisis before resorting to admission. Funding opportunities are restricted for the development of crisis services. The development of emergency response services for the use of current staff from a number of community mental health teams is an option worth considering.