To describe the extent and variation in the use of Guardianship nationally. The Directors of Social Services were asked to provide details about Guardianship cases on two separate occasions one year apart.

There were 428 new Guardianship cases in 12 months. At the second enumeration, 73% of cases were within the mental illness category and 47% of these had serious mental illness.

There is much variation in the use of Guardianship. Further developments of this study will explore the reasons for this variation and will ascertain clinicians' views on Guardianship, supervised discharge and other community treatment orders.

A questionnaire survey of all memory clinics in Scotland to obtain information about clinic characteristics, assessment techniques and prescribing practice.

Memory clinics are a common component of old age psychiatry services within Scotland. There is variability in clinic characteristics, assessment techniques and treatment approaches. Most clinicians appear to rely on their own clinical judgement rather than national guidelines when making decisions about investigations and the prescription of anti-dementia medications.

There is considerable variation in memory clinic practice across the country. Would standardisation of practice ensure equity in service provision/patient care? However, would such standardisation be at the cost of clinical autonomy?

A questionnaire was sent to members of the Psychotherapy Section of the Irish Division of the Royal College of Psychiatrists to assess psychotherapy training.

Members from Northern Ireland, compared with those from the Republic, had more mandatory psychotherapy experience in a variety of psychotherapies, had attended more lectures on the theories of the psychotherapies, had cases longer in analysis and were more satisfied with their level of supervision. Few non-consultant hospital doctors had obtained mandatory psychotherapy training as outlined by the College guidelines and they were also generally dissatisfied with their basic training in psychotherapy.

Although there were clear qualitative differences in psychotherapy training between Northern Ireland and the Republic, 100% of members believed there should be improvements in the training of psychotherapy in Ireland. If the Royal College guidelines are to be adhered to, these results would imply that changes in the structure of psychotherapy training in Ireland particularly for non-consultant hospital doctors are required.

The assessment of the future dangerousness of firesetters is problematical but psychiatrists may be requested to perform assessment of arsonists for the courts. We surveyed the views of psychiatrists and others (n=54) on how 11 candidate historical variables might contribute to future dangerousness.

Hierarchical cluster analysis indicated that variables fell into three groups related to level of perceived dangerousness. Apparent intention to endanger life and setting fire to an occupied building were the items thought by psychiatrists to most indicate highest future dangerousness. Having previously set fires that caused extensive damage, failure to extinguish previous fires or alert the authorities were perceived as indicating moderate future dangerousness.

The study adds to what is known about how psychiatrists formulate assessments of future dangerousness.

David Gilbert is Director of InHealth Associates Ltd, a small consultancy organisation that supports patient and public engagement.

To describe physical sequelae of cylindrical battery ingestion and their management by description of recent cases and literature review.

X-rays should be performed to determine the position and integrity of the battery. In the absence of abdominal symptoms, immediate surgical opinion may not be indicated.

Conservative management of battery swallowing is frequently possible.

Dementia and depression are common psychiatric diagnoses in older people, and are common reasons for referral to liaison psychiatry services. The present study examined the accuracy of physicians' diagnoses for both disorders in consecutive referrals to a liaison old age psychiatry service.

Positive predictive values for depression and dementia were high, but levels of treatment of depression and documentation of past psychiatric history were both poor. Alcohol misuse and stroke accounted for the commonest accompanying disorders.

The findings have implications for the encouragement of physicians to treat depression when this is suspected. Educational programmes for this purpose may be useful, incorporating an exploration of attitudes and knowledge of physicians towards depression in older people.

Accumulating evidence suggest that psychiatrists may be at greater risk of being stalked compared with the general population. We used a self-administered questionnaire to survey psychiatrists in Ireland about their experiences, practices and attitudes regarding work-related stalking.

We found that 25.1% of psychiatrists in Ireland had been the subject of stalking behaviour at some point in their career. At the time of the survey, 5.5% of respondents were actively being stalked. The majority of the stalking occurred in the workplace and most of the perpetrators were patients. Most of the victims were unaware of guidelines or other supportive mechanisms in their workplace. Of those who reported their experiences to authorities, almost half were not satisfied with the support they received.

Stalking of psychiatrists is not uncommon. Employers should put in place supportive structures backed up by education and training to reduce the incidence, associated morbidity and other wider consequences of stalking.

To compare effectiveness of long-acting injections in schizophrenia and related psychoses in Lanarkshire, Scotland, from 2002 to 2008. We retrospectively assigned Clinical Global Impression (CGI) scores and examined discontinuation and hospitalisation rates.

Risperidone, zuclopenthixol and flupentixol were associated with CGI improvement in 72-74% of individuals. Zuclopenthixol was associated with lower rates of discontinuation as a result of inefficacy compared with risperidone (hazard ratio (HR) = 0.11, 95% CI 0.05-0.27) and flupenthixol (HR = 0.14, 95% CI 0.05-0.39), and lower rates of hospitalisation compared with risperidone (HR = 0.32, 95% CI 0.17-0.56) and flupentixol (HR = 0.34, 95% CI 0.16-0.71). ‘Very much improved’ or ‘much improved’ on the CGI was seen in risperidone (29%), zuclopenthixol (16%) and flupentixol (37%), P<0.001.

No long-acting injection was clearly superior in all our outcome measures, supporting the continued need for a variety of long-acting depot antipsychotics to optimise the treatment of the range of patients seen in clinical practice.

The need for training in the management of personality disorder is now firmly established following publication of policy implementation guidance for the development of services for people with such disorders. We report on the development of a training course for people from a range of disciplines, which is group-based, psycho-analytically informed and experiential in nature.

Those attending the course rated it highly. They showed marked changes in attitude towards, and greater confidence to work with, the client group, and were more willing to communicate their own difficulties openly both within and between agencies, to pass on their skills and to develop further the networks they had formed.

Given a containing structure and reflective space, professionals from a number of agencies rapidly become able to use difficult theory to develop a ‘feeling language’ to communicate about clients with personality disorder. User presentations can be important to these changes. Repeating such a course over a number of years might lead to a more therapeutic culture within mental health services and associated agencies. The course format is likely to be transferable.

To describe the characteristics of probationers assessed (n=83) and supported (n=31) by a mental health worker (MHW) attached to a probation service. A survey of cases and case descriptions.

Referrals were predominantly White, unemployed males on probation orders. Most had acquisitive/property and violent convictions along with substance misuse problems and personality disorder diagnoses. The MHW supported probationers already in contact with psychiatric services and provided a safety net and sometimes sole support, to those who were not.

The MHW helped to bridge the gap between criminal justice and mental health systems by facilitating contact between probationers and psychiatric services. The clinical effectiveness of the scheme should now be examined.

In order to examine the opportunities for senior house officers (SHOs) to undertake emergency psychiatric assessments we conducted a retrospective cohort study of such assessments in a district general hospital.

Senior house officers conducted few assessments for self-harm compared with psychiatric liaison nurses (P < 0.001), and were involved in only 40% of emergency referrals where psychiatric opinion was requested. Senior house officers continue to undertake more assessments out of hours than any other group (P < 0.01).

Although the introduction of psychiatric liaison nurses has improved capacity and reduced waiting times for emergency assessment, the opportunity for SHOs to undertake emergency assessments has been reduced, particularly with regard to assessment of suicidal risk following self-harm. These results suggest the need for better monitoring of SHO experience, particularly in the light of service developments that have an impact on psychiatric training.