To study the use of antidepressants in adults with intellectual disability, focusing on medication type, indication, retention and clinical outcome. Case notes of all service users in a learning disability service were hand-searched to identify antidepressant usage, and those who had been treated with antidepressants and in whom at least 1 year of follow-up was possible were included in the study.

A total of 241 treatment episodes were identified. The rates of positive outcome in terms of clinical improvement at 6 weeks, 6 months and 12 months were 49.4%, 48.1% and 49% respectively, and only 29 (12%) episodes of side-effects had been noted.

Antidepressants are commonly prescribed in adults with intellectual disability. Approximately half did well in terms of clinical improvement.

All child and adolescent psychiatrists and community paediatricians in the former Trent Region were surveyed about their antipsychotic prescribing practice during 1 year, including monitoring, and whether they would like consensus guidelines on prescribing and monitoring of antipsychotics in children and adolescents.

The majority (88%) of child psychiatrists and 33% of paediatricians had prescribed atypical antipsychotics, most commonly risperidone. Only two psychiatrists had prescribed a typical antipsychotic and no paediatrician had done so. Challenging behaviour in developmental disorders was the most common indication for atypicals. Both child psychiatrists and paediatricians prescribed atypicals for non-psychotic developmental disorders, whereas prescribing for psychosis occurred almost exclusively among psychiatrists. Height, weight and blood pressure were routinely monitored, but waist circumference was rarely measured and there was wide variation in the monitoring of other parameters such as blood glucose, prolactin and extrapyramidal side-effects. Three-quarters of the participants felt there was a need for guidance on prescribing and monitoring atypical antipsychotic therapy.

The greater prescription of antipsychotics by child and adolescent psychiatrists may reflect differences in case-load and training. Routine monitoring of adverse effects is inconsistent among prescribers. The survey highlights the need for training and guidance on prescribing and monitoring of atypical antipsychotic use in children and adolescents.

To describe the psychotropic medication given to 332 patients admitted consecutively to seven English psychiatric intensive care units (PICUs) by prospective, multicentre case-note analysis.

Overall, 104 (32%) patients received rapid tranquillisation or zuclopenthixol acetate by intramuscular injection; 72 (23%) received more than one regular antipsychotic drug simultaneously. It was reported that 20 patients received high-dose antipsychotic medication, which was probably an underestimate. The use of these interventions varied significantly between different units.

Potentially risky treatments such as forcible intramuscular medication are a standard part of PICU activity. Further work is needed to clarify the reasons behind the differences in prescribing practices between different PICUs.

To study the effects of patient suicide on both personal and professional life of consultant psychiatrists in Ireland. A questionnaire was sent to all practising consultants.

Most respondents (80%) had experienced patient suicide in their careers; in up to 97% it had an impact on either their professional or personal life. The most common effects were preoccupation with the suicide and guilt. Unpredicted suicides and perceived effect on patients' families worsened the distress. Informal support was of most help, with a large proportion of study participants suggesting independent case review would be helpful.

Patient suicide is an almost universally distressing event for psychiatrists. Although consultants receive psychological support from family and friends, many would also welcome an objective professional review.

To consider the link between responsible commissioner and delayed prison transfers. All hospital transfers from one London prison in 2006 were audited and reviewed by the prisoner's borough of origin.

Overall, 80 prisoners were transferred from the audited prison to a National Health Service (NHS) facility in 2006: 26% had to wait for more than 1 month for assessment by the receiving hospital unit and 24% had to wait longer than 3 months to be transferred. These 80 individuals were the responsibility of 16 different primary care trusts. Of the delayed transfer cases (n=19), the services commissioned by three primary care trusts were responsible for the delays.

There are significant differences in performance between different primary care trusts related to hospital transfers of prisoners, with most hospitals able to admit urgent cases within 3 months. This suggests that a postcode lottery operates for prisoners requiring hospital transfer. Data from prison services may be useful in monitoring and improving the performance of local NHS services.