Most clinicians understand the advantages of basing their practice on the best available evidence, but sometimes doubts are voiced about the feasibility of applying the strategies of evidence-based medicine (EBM) in everyday clinical practice. This article describes one strategy for beginning to use EBM in ‘real-time’ which could already be used by the majority of clinicians. The rapid developments in clinical informatics are likely to enhance the feasibility and value of this strategy.

HIV infection is a relatively new disease affecting families (Pizzo & Wilfert, 1994). As with other chronic and life-threatening illnesses, families are faced with many changes and losses as well as much uncertainty about the future (Eiser, 1990). Unlike most other conditions, however, there can be extra stigma-related stresses, such as fear and secrecy, which can compound existing burdens of illness and coping (Richmond & Ross, 1995). As further knowledge of the full impact on HIV on families evolves, there is a need to consider the effects of multiple loss and changes on the mental health and adjustment of the children as well as their parents (Melvin & Sherr, 1995; Reidy, 1995).

Self-injury is a major clinical problem on the women's wards at Ashworth Hospital. Ashworth Hospital is one of three special hospitals within England and Wales that provides assessment, treatment and rehabilitation for those legally detained patients under the Mental Health Act (1983) who suffer from a mental disorder and require conditions of special security because of their dangerousness. There is extensive literature on the psychological aspects of serf-injury. However, since patients with self-injury present with damage to the body, it is surprising that there is little information on the physical health care and associated resource costs of this behaviour.

Clinical studies suggest that risperidone is an effective antipsychotic with a low incidence of extrapyramidal adverse effects. In a prescription survey of several trusts, we found that risperidone was widely prescribed at high doses alongside typical neuroleptics and anticholinergic drugs. We also demonstrated that prescribing in a single trust can be improved by simple interventions. Risperidone should be prescribed as the sole antipsychotic at doses below 8 mg/day to realise fully its clinical advantages. Few prescriptions met this standard.

Mental health services have been criticised for failing to respond to the needs of the rising number of homeless mentally ill. We report on the first year of referrals to a community mental health team established to meet the needs of the severely mentally ill homeless in Birmingham. Most users had a psychotic disorder and a lengthy history of unstable housing, and experienced a range of other disadvantages. Although the team is successfully reaching its priority group, examination of other characteristics of users has highlighted a number of issues which should inform the future planning and development of the service.

A survey was undertaken to ascertain if doctors working in psychiatry knew when to perform electrocardiograms (ECGs) prior to and during psychiatric treatments where indicated, and to investigate the training, confidence and ability of doctors in ECG interpretation. Half had received no training in the indications for performing an ECG. Opinion differed widely as to when to perform an ECG, with 54% stating an ECG was required before treatment with pimozide and only 19% and 11% stating ECGs were required during the course of treatment with pimozide and high dose antipsychotic medication respectively.

Ability in ECG interpretation correlated negatively with time spent in psychiatry but no correlation existed between grade and ability to identify an ECG as normal or abnormal.

Ninety-five countries throughout the world retain the death penalty. All make provision for excluding the ‘insane’ from liability to capital punishment (Hood, 1990). Psychiatrists and other mental health professionals are therefore involved in the process leading up to capital sentencing and execution in many of these countries. Such involvement may take many forms though, with the notable exception of the USA, very little is known of its nature or extent in practice. Whatever form psychiatric involvement takes, and however much it may be shaped in different places by social, economic and cultural variables, as well as the configuration of particular criminal justice systems, certain fundamental ethical questions arise which do not admit of simple answers. It might be argued that these ethical dilemmas no longer have relevance to European countries because they have all effectively abolished capital punishment. However, others may claim that the death penalty, as the most spectacular example of the extra clinical harm to which a psychiatrist's dealings with patients may contribute, ought to be of central concern when practitioners come to consider the uncertain balance between their duty to an individual patient and society at large.

The role of carers is explored in the process beginning with the early detection of changes in cognitive function through to the diagnosis of dementia. Carers were not always aware of early cognitive decline before other family and friends. Forty-five per cent of initial diagnoses were made by GPs. In over 50% of cases, the sufferer had not been told their diagnosis by health professionals or carers. A quarter of carers wanted more information about dementia even after referral to specialist services. The importance of early referral and provision of sufficient comprehensive information about dementia are discussed.

The Scottish Liver Transplantation Unit (SLTU) opened in the Edinburgh Royal Infirmary in November 1992. We describe the liaison psychiatric input during its first 23 months. Sixty-five patients were seen from 69 referrals and their case notes were studied retrospectively to obtain information on patient demographics and details of each psychiatric involvement. A high level of psychiatric morbidity was found and psychiatric opinion contributed to the transplant assessment procedure. Our results indicate the need for good liaison psychiatric input with subsequent resource implications.

A retrospective case note study explored readmissions to an acute psychiatric in-patient unit within six months of discharge. The study aimed to calculate a hospital readmission rate, to investigate the timing of readmissions, and to identify risk factors associated with readmission. The readmission rate was 27% with the majority of readmissions occurring within three months after discharge, suggesting the need for investigation of such early readmissions. The three factors found to predict readmission were: discharge against medical advice, number of previous admissions, and living alone or with family rather than in care. Implications for hospital service planning are considered.

The loss of psychiatric beds associated with the closure of large psychiatric institutions creates problems for the community care of those with severe mental Illness. This paper describes the use and possible advantages of a non-acute in-patient unit attached to a Community Menial Hearth Centre in North Staffordshire which has prioritised Individuals with severe mental Illness.

This is the first of two papers which summarise key concepts in health economics and explains the differences in the various types of economic evaluation published in the economics literature. Examples from the economic analysis of mental health care are used to illustrate the key points. This paper explains the concepts of scarcity, rationing, opportunity cost and efficiency from a health economics perspective, and presents an ethical argument for the use of health economics in making decisions on resource use in mental health care.

This study presents the pattern of assessment and 6-month out-patient attendance of 54 children and adolescents who took an overdose over a 12-month period, and were assessed by a district child and adolescent psychiatry service. Attempts were precipitated by arguments (67%) or school-related stressors (19%). In 70.4% of cases, analgesic tablets were used. A psychiatric disorder was present in 51% of the cases. At 6 months, 13% of the patients were still attending for follow-up, while three children (5.5%) had taken a second overdose. Admission to a paediatric ward can facilitate the initiation of treatment. Child mental health services should aim at providing prompt assessment, good communication with other agencies, and follow-up arrangements, particularly with high-risk young people and their families

Accident and emergency (A&E) staff completed a general knowledge and attitude questionnaire related to suicide and deliberate self-harm (DSH) before and after a teaching package. The results showed an increase in general knowledge while attitudes remained the same. Following the teaching package there was an increase in the number of patients who contacted the Specialist Service for DSH.

In childhood sexual abuse cases, the non-abusing parent (usually the mother) is often seen as colluder, helpless bystander or victim. These negative views may be based on misconceptions about incestuous families and can lead to treatment bias and neglect of the other ‘victims' of abuse. Mental health professionals and support agencies should ensure that the needs of the non-abusing parent are met as well as those of the victim and perpetrator.

Adolescent in-patient units within the NHS generally provide a broad range of services to large catchment areas and populations. ‘Pine Lodge’ Young People's Centre in Chester has piloted a new emergency admission service which it has run in conjunction with its existing treatment service. This paper sets out to discuss the potential difficulties in providing such a service in the setting of a general purpose adolescent unit; describe the specification of the piloted emergency service; and present the results of monitoring its use and efficacy during the first six months.

Controlled trials show that about 80% of schizophrenic patients remain relapse free when given adequate neuroleptic maintenance therapy but this level of efficacy is not achieved in clinical practice. Guidelines for proper use of neuroleptics in relapse prevention were developed by a group of experienced psychiatrists – the ‘Consensus Group’ – in 1989. In this survey, the views of UK psychiatrists, GPs, CPNs and pharmacists involved in community care of schizophrenia were compared with the Guidelines.

A survey was undertaken at the beginning of 1995 of all the patients in the Bexley Hospital. Demographic information was compared with the findings obtained from a previous survey conducted in 1986. Results indicated that during the 9–year interval, changes had occurred in the characteristics of the population. Most markedly, the group was younger than that originally studied, and the total proportion of legally detained patients had increased. If such trends are representative of the country at large, adequate planning must be made to cater for an ever-evolving patient group.

Many psychiatric hospitals in the UK have closed. Factors influencing staff morale around the time of a hospital closure will affect the functioning of that institution. This study surveyed staff anxieties, attitudes and expectations in a major psychiatric hospital three weeks prior to its closure. We found evidence of widespread denial despite energetic dissemination of information. There were also significant differences between staff groups. Our findings will have implications for the management of future hospital closures.

“We have to get it into our heads that a hospital is like a shell, a framework to contain certain processes, and when the processes are superseded, the shell must, most probably, be scrapped and the framework dismantled” (Enoch Powell, 1961).

A postal questionnaire survey of intensive care units/ locked wards in Scottish psychiatric hospitals revealed a lack of structural security features (other than a locked door) and an absence of personal alarm systems for staff in a substantial minority of units. The main reasons for transfer to locked units were physical violence to others and absconding risk, and the commonest diagnosis was schizophrenia. Transfer of in-patients not detained under mental health legislation was not uncommon. Differences in practice with regard to the transfer process were evident. In Scotland local locked facilities play an important role in secure provision and further evaluative research is required.