To assess the impact in the South London and Maudsley NHS Foundation Trust of a 20-month quality improvement programme on adherence with National Institute for Health and Clinical Excellence (NICE) recommendations for the use of valproate for bipolar illness in women of childbearing potential.

Significant improvement was noted between baseline and final audit in rates of information provision (10% v. 63%, P < 0.0001), contraceptive use (15% v. 38%, P = 0.0003) and folate prescription (3% v. 35%, P < 0.0001).

Adherence to guidance can be usefully improved by a sustained intervention programme.

This cross-sectional study investigated the evolution of intentions among medical students to pursue a career in psychiatry and the factors that might discourage them from becoming a psychiatrist. A questionnaire survey was sent to medical students in years 1–5 at Aberdeen University.

From 918 students, 467 (51%) returned useable responses. Proportions of students across the 5-year groups who definitely or probably intended to become psychiatrists remained fairly stable at 4–7%. In their final year, psychiatry remained a possible career option for a further 17% of students. The most potent discouraging factor was the perception of poor prognoses among psychiatric patients. Perceptions of a lack of scientific/evidence base reduced enthusiasm for becoming a psychiatrist. Issues relating to the prestige of the specialty were also important.

If recruitment to the specialty is to improve, these negative perceptions among students should be addressed by their teachers and more widely within psychiatry.

To appraise the value of additional information from objective measurements (QbTest system) in the clinical assessment of children and adolescents with attention-deficit hyperactivity disorder (ADHD). Two groups of ADHD assessments were compared. In the first group, assessments were undertaken without objective measures, whereas in the second group objective measures were added to the assessment. Practice outcomes were followed up over 1 year.

Objective measures improve differentiating between ADHD and other conditions whose symptoms are known to overlap with ADHD. Objective measurements reduce the risk of unidentified ADHD (P < 0.0035) as measured by subsequent rates of revised diagnosis over a 12-month period.

Introducing objective measurements into the clinical assessment of ADHD provides an increased robustness of the clinical diagnosis strengthening clinical decisions for treatment interventions.

Using the National Institute for Health and Clinical Excellence (NICE) guidelines on borderline personality disorder as a framework, we describe the profile of the first 100 individuals referred to a personality disorder service in London, captured through the use of record review and case study.

The referral population ethnic profile does not match the wider population of the borough; a third of the borough is Bangladeshi, but only 9% of those referred to the service are. Of those diagnosed with borderline personality disorder and on psychotropic medications, only one person had a clear current indication based on NICE guidelines. Of the 100 individuals who were referred to the service, a quarter were accepted to the programme; a third either did not want to proceed with the assessment or were unprepared for an intensive programme.

The under-representation of Black and minority ethnic individuals in referrals in the peresonality disorder service needs to be actively addressed. Interventions are required to support psychiatrists in reviewing their prescribing practice regarding individuals with borderline personality disorder. Access to the service needs to be improved.

A group of lawyers, psychiatrists, best interest assessors and independent mental capacity advocates were asked to make binary judgements about whether real-life situations in 12 vignettes amounted to deprivation of liberty. Kappa coefficients were calculated to describe the level of agreement within each professional group and for the total group of professionals.

There was total agreement between all professionals about deprivation of liberty in only 1 of the 12 cases. The overall level of agreement for judgements made by all professionals was ‘slight’ (κ=0.16, P < 0.01).

There are practical difficulties involved in making reliable deprivation of liberty judgements within the Deprivation of Liberty Safeguards (DoLS) legislation. A clear interpretation of deprivation of liberty is necessary to facilitate professionals' decision-making in this area.

To compare attitudes towards mental disorders in professionals working in mental health and professionals working in different areas of medicine. Levels of emotional empathy in both groups were also investigated. In total, 58 mental healthcare professionals and 60 non-mental healthcare professionals completed our attitudes towards mental disorders questionnaire and Balanced Emotional Empathy Scale.

The results reveal generally positive attitudes towards people with mental disorders in both groups. Non-mental healthcare professionals regarded people with a mental disorder as significantly more dangerous and unpredictable than did mental healthcare professionals. There was no statistically significant difference in emotional empathy between the two groups. Both groups cited illicit drug use as one of the most significant causes of mental disorder.

Mental healthcare professionals and non-mental healthcare professionals show broadly similar attitudes and a similar degree of empathy towards people with a mental disorder. However, non-mental healthcare professionals regard people with mental health problems as significantly more dangerous and unpredictable. There is scope for further research including examining the effects of educational interventions.

To evaluate the effectiveness of the Harrow Assertive Outreach Team in reducing hospital admissions. We compared first- and second-year admissions of a cohort of 76 patients.

Significant reductions in the number of admissions and number of days admitted were noted in the second year. In the subcohort of patients admitted in both years, the reduction in the number of admissions was significant but reduction in number of days admitted was not.

Hospital admissions may be reduced by appointment of consultant psychiatrist and approved mental health practitioner, home treatment approach and intensive case management.

To assess junior doctors' knowledge of the procedures involved in involuntary admission of patients detained under Sections 5(2), 2 and 3 of the Mental Health Act 1983. A semi-quantitative research study of junior trainees affiliated to two psychiatry training schemes was carried out.

Trainees' knowledge of professionally relevant sections of the Mental Health Act was patchy. Knowledge correlated significantly with experience in clinical practice and with experience of using mental health legislation. Surprisingly, in-service training in mental health legislation had no effect on participants' knowledge.

Lack of knowledge and understanding raises the possibility of inappropriate use of the mental health legislation. This threatens patients' fundamental rights and can lead to complaints or litigation. There is a clear need to address this at an early stage in psychiatry training.

We hypothesised that, because of stigma associated with mental illness, patients' knowledge of psychotropic medication would be less than that of non-psychotropic medication. We set out to establish the extent of knowledge about these medications using a cross-sectional survey of in-patients over 65 years of age in south London.

Of the study population (n = 86), 42% demonstrated an understanding of the purpose of taking both psychotropic and non-psychotropic medication, 15% understood only their psychotropic medication, 16% understood only their non-psychotropic medication and 27% understood neither medication. A surprising finding was that more than 20% of these patients with cognitive impairment were not able to recount their legal status; this factor was independently related to whether or not they knew the purpose of their psychotropic medication, and also whether or not they knew the purpose of neither type of medication.

Poor knowledge of medication has been associated with non-adherence and relapse. Older adults are likely to receive multiple medications because of their increased susceptibility to physical and psychiatric disorders with increasing age, so even more emphasis has to be placed on increasing knowledge of medication.

To assess the stability of the diagnosis of first-episode drug-induced psychosis over a follow-up period of at least 2 years. Patients with no psychiatric history who had been discharged from in-patient care between January 2002 and April 2006 with a firm diagnosis of drug-induced psychosis were identified. Follow-up information for at least the next 2 years or until discharge from mental health services was collected retrospectively from psychiatric records.

Nearly all of the patients who remained under psychiatric follow-up had a change in diagnosis, most commonly to a schizophreniform disorder. Those who were retained in follow-up had significantly longer index admissions than those discharged to primary care (P = 0.05).

This study suggests that many individuals diagnosed with drug-induced psychosis are further diagnosed as having a functional psychosis, usually schizophreniform in nature. This is compatible with the suggestion that individuals diagnosed with drug-induced psychosis are experiencing either the effects of drug intoxication or an ordinary functional psychosis complicated by incidental drug use.

To examine the association between the use of cholinesterase inhibitors (ChEIs) and time to care home placement. We compared patients who were prescribed ChEIs in 2006 with those who were not with respect to their placement in care homes over a 4-year period, using survival analysis.

During the first 30 months of follow-up there was a delay in care home placement by a median of 12 months in those who took ChEIs compared with those who did not. However, at the end of the follow-up there was no significant reduction in the probability of being in a care home setting between those who had taken ChEIs compared with those who had not (hazard ratio 0.75, 95% CI 0.25–6, P = 0.1).

The study provides some evidence to suggest that prescribing ChEIs may be associated with a delay in the timing of care home placement as observed in the first 2.5 years of treatment. However, based on purely observational data, no conclusion can be made as to whether such association is causal.

Following recommendations made by our 2004–2005 audit, we carried out a re-audit of the local Section 297 protocol in 2007–2008. Our aim was to establish the quality of documented information provided by the police; adherence to the protocol; completion rates of documentation; and rates of notification to the Mental Welfare Commission for Scotland, in keeping with the standards set in the Code of Practice of the Mental Health (Care and Treatment) (Scotland) Act 2003.

We reliably traced 84 POS1 forms completed in accordance with the protocol. The audit identified a rate of 74–89% notification to the Mental Welfare Commission for Scotland. By comparison, there is a surprisingly wide variation in notification rates across Scotland. Good-quality information was given by the police, despite receiving no additional training.

This audit highlights a serious lack of information about place-of-safety legislation in Scotland. For patients in the catchment area, the joint protocol and use of standard documentation has significantly standardised patient care. Other health boards and police forces should consider this as they implement legislation.

We examined the effect on civil sections and the rate of appeals against them of the amendments made to the Mental Health Act 1983 as a result of the Mental Health Act 2007. We gathered data for the year before and after the introduction of these changes.

We found increased use of Section 2 (56.8% before and 65.8% after (P < 0.001)) and decreased use of Section 3 (39.5% before and 31.2% after (P < 0.001)). The number of appeals against civil sections decreased (697 before and 692 after) but there was an 8.0% increase in the proportion of appeals to mental health tribunals. There was a decrease in admissions under these sections (817 before and 733 after).

These changes may be unintended consequences of the new law, resulting in increased workloads for psychiatrists and costs to the National Health Service.