To dissect duration of untreated psychosis (DUP) into three components: help-seeking delay, referral delay and delay in mental health services, all mental health services in a defined geographical region were screened over a period of 1 year. All cases of first-episode psychosis without a primary mood disorder were identified (n=55).

The median delay within secondary services was over seven times the delay in the referral pathway. The mean delay in mental health services accounted for 35% of overall DUP.

Intervention is required in secondary as well as primary care services if DUP is to be reduced.

To evaluate the effects of a crisis resolution and home-based treatment team upon in-patient admission rates. We collected data for 2 years prior and 1 year post-implementation of such a service in Leeds. The chosen time frame allowed the new service to settle in and controlled for seasonal variations.

There were 4353 admissions during the period of the study, with 3325 in the 2 years prior to the service and 1028 in the year after. Generalised linear analysis found a 37.5% reduction in monthly admissions after the introduction of the team (P < 0.0001).

This study shows that in everyday clinical practice crisis resolution and home treatment teams lead to a sustained reduction in in-patient admission rates.

To develop a scale to measure social satisfaction in people with substance use disorders and to test its psychometric properties. The rationale is that social satisfaction is more universal and relevant to treatment planning than assessing social problems. The new Social Satisfaction Questionnaire (SSQ) was derived from an existing social problems questionnaire and validation was undertaken on two large clinic populations.

An eight-item SSQ was tested and found to have good psychometric properties in terms of test–retest reliability, internal consistency, distribution of responses and concurrent validity.

The SSQ is suitable for use as the social domain element of an outcome measures package.

We present two patients who developed refeeding syndrome following admission to a general psychiatry ward. The practical implications of assessing and managing medical consequences in patients with mental illness who start refeeding after a period of starvation are discussed.

Patients presented with overlapping clinical manifestations of mental illness and refeeding syndrome that were difficult to recognise and manage.

Awareness of refeeding syndrome in patients with mental illness may prevent fatal physical complications.

The Human Rights Act was incorporated into UK law in 2000, but little is known about how it is implemented in psychiatric care. We explored the understanding of multidisciplinary teams of the restriction and protection of patients' human rights using an open-response questionnaire. Content analysis was employed to summarise written, narrative data about the human rights of 102 patients in secure psychiatric care.

Our clinical teams considered human rights to be protected through risk assessment and management, ongoing monitoring, local policy and existing UK mental health legislation. Understanding of the proper and proportionate restriction of ‘qualified’ rights (such as article 5 liberty) and the positive enablement and promotion of human rights (such as article 8 family and private life) appeared to be limited.

A cultural shift in focus is required in mental health services to understand and ensure positive promotion of human rights. Clinicians should directly address the human rights of their patients and articulate the rationale for proportionate restrictions of qualified rights. Clinical policy, training and audit should explicitly embody the protection of human rights.

Following a survey in 2001, a protocol for monitoring weight and blood glucose of psychiatric in-patients receiving antipsychotic drugs was developed. The effect of this protocol was investigated by comparing 61 admissions in 2004 with the 2001 in-patients.

No significant improvement in recording of admission weight or blood glucose was observed. Ongoing monitoring of weight after admission was significantly more common. For only 29% of patients studied in 2004 was there complete adherence to the protocol.

In spite of the availability of a protocol and education, the results suggest that monitoring of weight and blood glucose is still haphazard for psychiatric in-patients. The implications for out-patient monitoring are discussed.

To explore relationships between different styles of working and measures of occupational pressure in consultant psychiatrists. A random sample of 500 consultant psychiatrists were sent a questionnaire about working patterns and lifestyle factors, with other sections using validated tools (such as the 12-item General Health Questionnaire; GHQ).

There were 185 useable questionnaires returned (an adjusted response rate of 39%). Significant relationships were identified between job content and GHQ and burnout scores, indicating that occupational pressures are rendering some consultant posts ‘problem posts', leading to problematic levels of psychological distress among some consultants.

Although consultant psychiatrists are more satisfied than not with their jobs, steps need to be taken to address the causes of ‘problem posts', to reduce attrition in the most pressured individuals.

An audit in a general hospital accident and emergency (A&E) department and the subsequent development of a triage process for people presenting with self-harm is described. A random sample of 103 people attending with self-harm were selected and their treatment audited against standards derived from NICE guidelines.

The service provided by the A&E department was sub-standard. Of particular concern was the lack of processes addressing risk assessment and safe discharge. A pro forma was designed with the aim of improving assessment of self-harm. A repeat audit 3 months after introduction of the pro forma showed an improvement in the recording of relevant information underpinning risk assessment.

Procedures for those presenting to A&E departments with self-harm may not meet recommended guidelines. The use of a pro forma with staff training can improve risk assessment.

A study was undertaken to investigate the views of professional staff and paid and informal carers' views of a new integrated mental health service for people with learning disabilities.

Twenty semi-structured interviews were conducted and transcribed. Most staff and carers were generally satisfied with the in-patient facility. However, information exchange, ward rounds and the ward environment were identified as areas requiring improvement.

Many of the participants had no previous experience of supporting a person with learning disabilities and mental health problems in an in-patient setting. However, over time they became supportive of the mental health service and provided valuable input in improving the service provision for people with learning disabilities.

By use of a postal survey we sought to determine attitudes and beliefs about recruitment to psychiatry. Members of the Scottish Division of the Royal College of Psychiatrists were asked to complete a questionnaire asking their views on the importance of various factors in relation to recruitment (n=387).

Response rates were low from non-consultants and we focused on the views of the 212 consultants (55%) who responded. The perceived low status of psychiatry among other doctors and the belief that individuals with psychiatric disorders are difficult to deal with emerged as the two most important factors seen to affect recruitment. Improving undergraduate teaching in psychiatry was deemed important in enhancing recruitment.

Dealing with stigma, within and out with the profession, and improving undergraduate exposure to psychiatry may be important in recruiting doctors to psychiatry.

This study examined the 20-year outcome of 55 women who were pregnant and using opiates in 1985 and were attending the Drug Treatment Centre and Advisory Board, Dublin. We established outcome across a number of variables, including mortality, psychiatric and physical morbidity, psychosocial functioning, ongoing drug misuse and outcome of offspring.

At 20-year follow-up 29 women (53%) were deceased. HIV was the commonest cause of death, accounting for 17 deaths (59%). Those who were alive at follow-up displayed high rates of unemployment (84%), illicit substance misuse (74%) and most were dependent on state-subsidised accommodation (78%).

Mortality was higher in our group compared with other long-term follow-up samples. These findings suggest that such participants and their offspring require intensive long-term support and treatment.

A buprenorphine prescribing service was set up for opiate-dependent patients and the initiative was then audited using 11 standards.

Thirty-three patients met inclusion criteria for opiate detoxification and 7 successfully completed detoxification, equating to a number needed to treat of 5. However, 2-year follow-up data showed no clear advantage for these 7 patients compared with 9 patients who had failed detoxification at the outset. Only 5 of the 11 audit standards were satisfied.

The results suggest that a buprenorphine prescribing service may be of benefit to opiate-dependent patients in the short term. However, the audit standards identified may be unrealistic because of the likely lack of adherence of this patient group. Further work is needed to establish the feasibility of this treatment modality in ‘real-world’ settings.

To explore the impact of adults with personality disorder on the professional groups that support them. Staff (n=72) from five agencies participated in interviews focusing on reactions to short case vignettes representing the three personality disorder clusters.

Each presentation was relatively consistent in its impact on staff irrespective of the agency or setting. Several agency-specific themes were also identified, some illustrating areas of potential difficulty in inter-agency working. Many non-mental health workers reported considerable contact with this client group, although most felt dissatisfied with the training available and suggested solutions.

Findings from this study may help to match the content of training courses to need. Similar vignette-based surveys could be used to investigate the impact of staff training over time.

In order to meet revised (2005) Clinical Negligence Scheme for Trusts standards, tests of competency in key clinical skills were set for psychiatric senior house officers (SHOs) at the start of their posts.

The assessment of basic competencies demonstrated that 9 out of 14 SHOs met the required standards in tests of key clinical skills (overall competency rate of 64%). Senior house officers were generally in agreement with the principles behind the assessments.

Competency testing is becoming important at all stages of training and within all medical specialties. The recommended methods combine assessment of both knowledge-based competencies and clinical performance in the workplace.

We undertook three cycles of clinical audit of prescription charts to improve the quality of the prescriptions written in an in-patient unit. Pharmacy and medical staff reviewed a total of 1466 prescriptions on 242 prescription charts against local guidelines and provided feedback to medical staff. The pharmacist also regularly reviewed prescription charts on the wards between audits.

After three cycles of audit, 99.5% of prescriptions written were legible. The recording of drug allergies, section 58 status and patient age remained poor.

A combination of clinical audit and continual pharmacist review of prescription charts can improve the quality of prescriptions written by medical staff in an in-patient unit.

To investigate patients' subjective attitudes to electroconvulsive therapy (ECT) a questionnaire was posted to 89 consecutive patients who had received treatment in an ECT department.

Fifty-one responses were obtained (57%). Results indicated a high satisfaction with the department and the treatment itself; 44 respondents would or might have ECT again and 35 reported at least a modest improvement with ECT. However, a high rate (60%) of subjective cognitive impairment was reported.

Electroconvulsive therapy can be an acceptable treatment option for patients when administered in an accredited clinic. More research is urgently required to investigate the exact nature of ECT-associated cognitive impairment, in terms of functional deficits, severity and practical importance to patients' lives.

Despite extensive evidence that attention-deficit hyperactivity disorder (ADHD) and developmental coordination disorder commonly present as overlapping disorders, it is not clear whether clinicians routinely enquire about movement difficulties when assessing children with suspected ADHD. We describe a survey that examines knowledge and practice of child and adolescent psychiatrists (n=107) and paediatricians (n=51) in this area.

Results show that 67.3% of child and adolescent psychiatrists compared with 15.7% of paediatricians claimed to have poor or very poor knowledge of developmental coordination disorder, and 28% compared with 5.9% respectively reported that they never or only occasionally ask about motor difficulties.

Child and adolescent psychiatrists should consider routine screening for developmental coordination disorder when assessing for ADHD. Further training in assessment of developmental coordination disorder is recommended to facilitate this.

Involvement of service users in the research process and examination of recovery from psychosis are two topics that have generated recent interest within the research community. This user-led study examines the subjective experience of recovery in people with experience of psychosis. Seven interviews were analysed using interpretative phenomenological analysis and several themes emerged from the data.

Recovery from psychosis was found to be a complex and idiosyncratic process, which often involved rebuilding life, rebuilding self and hope for a better future (each of these themes consisted of sub-themes).

The importance of continuity of care, the need for greater choice in approaches aimed at alleviating distress, access to stories of recovery and encouragement, and the importance of more individualised recovery care plans are among factors highlighted.