The aim of the study was to survey strategies for dealing with patients who refuse clozapine blood tests or tablets. One hundred and twenty-five psychiatric intensive care unit consultants were sent a questionnaire.

Thirty-nine (31%) questionnaires were returned. Opinions and practices were diverse ranging from uncertainty around the legal right to enforce venepuncture, to the practice of slipping clozapine into a patient's drink without their knowledge.

There is need for an open debate of the relevant legal and ethical issues.

Smoking and substance misuse adversely affect the outcome of pregnancy and psychiatric patients are known to smoke more than other patients. Data collected at the time of routine antenatal booking were analysed to investigate whether pregnant women with mental health problems smoke more than other pregnant women.

Data were collected from 156 women. Those with a psychiatric diagnosis (n=76) were significantly more likely to smoke (P<0.001). Associations were also found with illicit drug use and previous termination of pregnancy. The most common psychiatric diagnosis was depression (62%). A diagnosis of schizophrenia was not recorded for any of the women.

The strong association between smoking and psychiatric diagnosis results in an increased risk of obstetric complications in psychiatric patients. Anti-smoking interventions might be delivered by adequately trained midwives and opportunistically during contact with mental health professionals.

The acute psychiatric inpatient service in Christchurch, New Zealand, recently changed from two locked and two unlocked wards to four open wards. This provided the opportunity to evaluate whether shifting to an unlocked environment was associated with higher rates of adverse events, including unauthorised absences, violent incidents and seclusion. We compared long-term adverse event data before and after ward configuration change.

Rates of unauthorised absences increased by 58% after the change in ward configuration (P = 0.005), but seclusion hours dropped by 53% (P = 0.001). A small increase in violent incidents was recorded but this was not statistically significant.

Although unauthorised absences increased, the absence of statistically significant changes for violent incidents and a reduction in seclusion hours suggest that the change to a less restrictive environment may have some positive effects.

This study was designed to clarify the nature and extent of psychiatric provision that would be needed if a new health screening protocol were to be introduced into the prison system. The reception screening questionnaires for every inmate coming into the prison over a 15-week period were reviewed using the new protocol. A further mental health assessment was undertaken on those who had screened positive.

201 men (32.6%) were found to be positive for serious mental illness

Based on this analysis, large increases in psychiatric resources would not be needed if the proposed new reception health screening processes were in place, although a reorganisation of the way in which services are delivered may be required.

Community treatment orders (CTOs) have been in used in England and Wales since November 2008; however, their effectiveness has been debated widely, as has the question of which methodology is appropriate to investigate them. This paper uses national data to explore the use of CTOs in England.

About 5500 patients are subject to CTOs at any one time. Each year, ~4500 patients are made subject to a CTO each year and ~2500 are fully discharged, usually by the responsible clinician; fewer than half of CTO patients are recalled, and two-thirds of recalls end in revocation. The low rate of CTO discharges by mental health tribunals (below 5%) suggests that they are not used inappropriately.

The introduction of CTOs in England has coincided with a reduction in psychiatric service provision due to the economic downturn. Pressures on services might be even more severe if patients currently subject to CTOs instead needed to be detained as in-patients.

None.

We aimed to survey clinicians' attitudes on using evidence-based guidelines. A postal questionnaire based on a previous survey of general practitioners was sent to 105 psychiatrists working within Avon and Western Wiltshire Mental Health Partnership NHS Trust.

There was a 91% response rate. Respondents were generally in favour of clinical guidelines, with scores indicating a positive attitude to guidelines in 13 of the 18 statements. The majority felt that guidelines were effective in improving patient care, could be used flexibly to suit individual patients and did not impinge on their clinical judgement.

Psychiatrists welcomed the increasing use of guidelines. Further research is needed to determine whether this will translate into actual use and improved outcomes for patients.

One objective of the Royal College of Psychiatrists' stigma campaign is to improve the public's knowledge about psychiatric illness. There has been little work in the UK on the public's knowledge of the training of psychiatrists and the treatments they use. Using a questionnaire, we compared a sample representing the general population (n=223) with a sample attending psychiatric outpatients (n=67) to assess their level of knowledge.

Half of the general population sample did not know that psychiatrists were medically qualified, and 80% underestimated the length of psychiatric training. There was variable knowledge of the conditions treated by psychiatrists and treatment methods used, with the outpatient group having better knowledge of drug treatments.

If the general public do not know about the training and expertise of psychiatrists, this is likely to limit their willingness to seek treatment for mental illness.

To evaluate the impact of involuntary out-patient commitment (OPC) in patients with severe mental disorder who use hospital services. This is a retrospective–observational study in a population of 91 patients under OPC. The psychiatric diagnosis, sociodemographic variables, who requested the court order and for what motive were studied. The study also looked at the use of the available health services (emergency room visits, admissions, average length of hospital stay) for the period beginning 2 years before and ending 2 years after the initiation of the OPC.

The number of emergency room visits, admissions and the length of hospitalisation diminished in the 2 years following the initiation of the OPC. In terms of diagnosis, the OPC has the most impact on individuals with schizophrenia and delusional disorder.

The OPC can be useful for certain patients with severe mental disorder, particularly individuals with schizophrenia and delusional disorder.