A case note study of antipsychotic prescribing in an inner London hospital showed that although doses of individual drugs were below the British National Formulary limits, polypharmacy occurred in a third of cases. Multiple regression analysis showed high doses were associated with a current risk to the self or others and increasing number of previous admissions in patients with mania and treatment non-responsiveness in schizophrenia.

The characteristics of clients admitted to a community support bed unit (SBU) serving an isolated, rural community were compared with those of clients from the same sector, admitted to a district general hospital (DGH) unit over the same period. There were few differences In the nature of the problems presenting to the two units, although there were more readmissions to the SBU, and more women tended to be admitted there. These results suggest that although the need for inpatient care remains for some patients, many who are currently admitted to such units can be managed in less institutional settings in the community. A support bed unit may play an important part in offering service users more choice about where and when they received help.

The Section of Old Age Psychiatry has compiled an informal register of old age psychiatrists using regional representatives as informants. This has been found to have a number of uses, but has also aroused concerns.

Since the Health of the Nation government document (Department of Health, 1992) set the target for the reduction of suicide in the severely mentally ill by 33% by the year 2000 it has become necessary to collect the suicide data for this population of patients at district and national level. There are a range of problems concerning the definition and identification of patients with severe mental illness as well as problems concerning the compilation of suicide data for this population at district level.

This case demonstrates some of the complex practical and legal difficulties in managing patients suffering from comorbidity of substance misuse and psychosis. A discussion of the ethical issues includes references to absolutist and utilitarian ethical models. Ethical dilemmas in such cases often impinge directly on clinical management, and the paper argues that the success or otherwise of treatment is partly dependent on awareness of such factors.

Of 299 referrals to the Dundee general psychiatry liaison service over a six month period, deliberate self-harm (DSH) was the reason in 83%. An overdose was used in 94%, and alcohol misuse occurred in 56% of DSH episodes. Fifty-two per cent of referrals were followed up by the general psychiatry service; 31% of these were admitted directly to a psychiatric ward, 10% on a compulsory basis. At follow-up, 23% remained in contact with the Dundee psychiatric service. Twenty-three per cent of all patients referred to the Area Alcohol Service (AAS) were in contact with it six months later. Clearly, liaison psychiatry has a role in detection and management of significant mental disorder.

The outcome of 19 long-stay patients discharged from a large psychiatric hospital to staffed group homes managed by a voluntary organisation were compared with 11 patients discharged to a hostel ward managed by an NHS Trust. The former were found to have a higher rate of police involvement, readmission and threatened eviction. The study highlights the need for an integrated range of different residential facilities and the necessity for close monitoring of long stay patients discharged to more independent community settings.

The prevalence of hepatitis B virus infection is thought to be higher in institutions for people with a learning disability than in the general population (Clarke et al, 1984). People with Down's syndrome are reported to be at higher risk than other learning disability groups. The prevalence of hepatitis B surface antigen (Hbs Ag) in Great Britain is in the order of 1 in 500 of the blood donor adult population (Department of Health, 1980). This rate is lower than those reported from countries in Europe, Africa and Asia. The present study was to identify those residents in an institution for people with a learning disability with a positive response to the test for Hbs Ag.

In this article we describe a six-month attachment to the Mental Welfare Commission for Scotland undertaken as part of higher professional training. We discuss the training benefits of such an attachment, emphasising the valuable overview it provided of mental health policy and the use of guardianship and leave of absence.

Following a visit to the Royal College of Psychiatrists by Professor W. J. Schudel, it was decided to visit The Netherlands with a view to gathering information about the organisation of postgraduate medical education In psychiatry there. Several Dutch psychiatrists were interviewed during the visit. The ‘Calman’ Report recommends limiting the period of training for British trainees. Formative methods of assessment are to be introduced, with a review of progress at regular intervals. The present Dutch system relies solely upon formative assessment.

At least one ethical committee is not prepared to approve open continuation studies of treatments for dementia. The author considers that such studies are an ethical necessity if patients are to give six months of their illness to trying out what may be placebo. The reasons for this conflict are discussed. In particular, it is suggested that such studies contribute real scientific information.

In most Asian countries child psychiatry is still in its infancy and the few specialists operating in this field have received their training overseas, usually in Europe or the USA. There is a perceived need for more expertise in child mental health and the unsatisfactory solution often adopted is for psychiatrists trained in adult work to move in and learn from experience.

This paper presents the coping strategies developed by one patient with 18 years experience of managing her own schizophrenic illness. The interventions which evolved gave her significant control over her illness. We report her experiences and emphasise that for some patients with treatment resistant schizophrenia, the patients themselves may have expertise in managing their symptoms.