The aim of this study was to examine the impact of prescribing clozapine for a cohort of patients with treatment-resistant schizophrenia in a local clinical service. Information was collected about the use of health care resources in the six months before and the six months after starting clozapine. Information was also recorded as to the effect of clozapine on daily living skills and overall clinical improvement.

The introduction of clozapine was associated with clinical befefits both in terms of overall clinical improvement and daily living skills. The introduction of clozapine was cost neutral in the first six months when taking into account both drug costs and total health care costs. The reduction in hospital bed usage did not occur untill the third and fourth year following the introduction of clozapine.

Although the drug costs of clozapine are higher than the use of traditional neuroleptics for treatments-resistant schizophrenia, the immediate overall costs of introducing colzapine were no higher than before the drug was introduced. Saving in hospital bed usage did not occur until after a period of hehabilitation. It is our impression that the clinical improvement brought about by clozapine enabled patients to benefit from the rehabilitation service to a greater extent than before the drug was started.

The study compared two methods of identifying patients prescribed high doses of antipsychotic medication among in-patients and out-patients in Buckinghamshire. High doses were defined as those in excess of 1000 mg chlorpromazine equivalents (CPZE) per day or more than 100% of the maximum recommended dose in the British National Formulary (BNF).

A total of 258 patients were identified as being prescribed antipsychotics, 30 of whom received high doses. There was 93% concordance between the two methods for identifying these patients. Nine of the 12 patients who had been prescribed high potency (> 1000 mg CPZE/day) but low toxicity (> 100% BNF maximum) therapy were receiving flupenthixol decanoate.

A group of six high-risk patients were identified who had been prescribed lower potency drugs at supra-maximal doses.

Expressing total antipsychotic dose as a percentage of the BNF maximum is easy to understand and calculate. It helps to ensure patients at risk of antipsychotic toxicity are easily identified to ensure monitoring guidelines can be followed.

The study explored job-stress experienced by psychiatrists, its effect on their lives and the coping mechanisms used.

The response rate was 62%. The younger group reported higher stress levels and used more positive coping strategies than the older groups. Female doctors were more likely to report being stressed. Aspects of the job experienced as most stressful include on-call duties and dealing with difficult and hostile relatives.

Anxietyand depressive symptoms are reported frequently in psychiatrists. Strategies to deal with the identified causes need to be put in place.

The aim was to review the assessment and management of the psychosocial risk (including substance misuse) of older children presenting to the accident and emergency department, with a view to making recommendations to improve services. The method used was to inspect casualty records of attendances over two weeks of 11-16-year-olds.

In no cases was any note made of whether substance misuse might have occurred. Cases of apparent psychosocial risk were, however, dealt with appropriately in the main.

Brief advisory guidelines were written for accident and emergency staff to promote consideration of the misuse of substances in older children, and an information leaflet was developed for young people and their parents.

This paper describes a 10-year alliance between an adult psychotherapy service and a child and adolescent mental health service to bring psychotherapeutically-informed help to families in difficulties early in the lives of their children.

It outlines staff training, the development of the unit into a significant training resource, the unit's underlying philosophy, its therapies and the key inter-relationships between teams and with health visitors to enable mutual teaming and the rapid access of families to assessment and treatment of the parent-child relationship.

Funding, future plans and the preventive and economic implications of such work are mentioned.