The study set out to consider whether the ‘end-of-firm’ examination in psychiatry fulfils its goals by examining the internal consistency of the end-of-firm examination and final medical board examination and the correlation between these examinations' scores and sub-scores. Students who failed their end-of-firm examination were followed to monitor their progress at final medical board examinations.

One hundred and eighty students sat end-of-firm examinations and final medical board examinations. All the components of the end-of-firm examinations and the final correlated significantly with the total mark. The psychiatric essay was less well correlated with the final mark but correlated well with total essay marks. Students who failed their end-of-firm psychiatry examination at first attempt received extra tuition and only two failed finals.

Essay writing ability may not carry over into high performance in other areas tested and may be a test of other skills. Extra tuition benefited failing students whose results fell outside the pattern of prediction. Thus the end-of-firm examination may be a useful tool if acted on to prevent student failure.

The aim of the study was to clarify the role of psychotherapy departments in relation to a general psychiatric service, and in particular community mental health teams (CMHTs). Literature reviews of therapeutic activities in CMHTs and of psychotherapy delivery methods were undertaken. The implications of the National Health Service Executive document on Psychotherapy Services in England was considered, based on experience of the psychotherapy-general psychiatry interfaces in North Devon and Bristol.

Psychological therapies are an integral part of psychiatric treatment provided in CMHTs, but are often delivered without careful assessment training or supervision. Psychotherapy departments contain expertise in the range of psychological therapies, but are sometimes perceived as remote from everyday psychiatric practice. Ways in which the divide between general psychiatry and psychotherapy might be bridged are suggested. A multi-disciplinary psychological treatment unit can offer specialist resources for the assessment and treatment of complex cases, especially those with personality disorders; psychological interventions in psychosis; and brief focused therapies for neurotic disorders unresponsive to drugs.

Consultation and liaison with the CMHT should become a key element in the work of a psychological treatment unit, and structured therapies under supervision similarly central to the work of CMHTs.

The aim of the study was to describe community mental health teams (CMHTs) working In Scotland. Interviews, a focus group, and a postal questionnaire survey of Identified CMHTs were carried out.

Of the 53 teams identified, 42 (79%) completed questionnaires. The average team size was 11 people. Community psychiatric nurses were in all teams, social workers and psychiatrists were in most, but psychologists were in only half. Needs assessments occurred in only 17% of teams. Fifty-one per cent of teams had open referral systems, and 38% of referrals comprised people with long-term mental health problems. Fifteen per cent of referrals were considered by teams to be inappropriate.

Ambiguities about appropriate structures, patient groups and interprofessional and inter-agency working require further consideration and evaluation if CMHT care is to be optimally effective.

Using a semi-structured questionnaire, we surveyed the patients attending an out-patient affective disorders clinic, enquiring about their knowledge of their lithium therapy.

The response rate was 68%. In general, the level of knowledge relating to their own treatment was good, however we were able to identify particular areas of deficiency in their theoretical knowledge.

The only factor we could identify which had a significant effect on patients' level of knowledge was having received education on lithium in more than one form.

This study aimed to examine medication refusal and its associated variables in a representative sample of patients on the Gloucester rehabilitation service case register. One hundred and seventy-four of 199 patients on the Gloucester rehabilitation register were surveyed. Insight cognitive function, knowledge of treatment, psychopathology and patient satisfaction were independently rated.

Thirty-five per cent of patients had refused treatment in the past month. Negative attitudes to treatment and historical indices of non-compliance were associated, identifying a consistent core of patients at continuing risk of refusal. However of refusers, 84% were persuaded within one month to take treatment, mostly by their community keyworker. Treatment refusal was associated with diagnosis of affective disorder, higher Brief Psychiatric Rating Scale score and failure to use a dosett dispenser, but not with insight cognitive function, satisfaction with treatment, knowledge of treatment, a range of illness and demographic factors or any particular treatment type.

Drug refusal was evidently mostly managed by community keyworkers, and without recourse to the Mental Health Act. Simple techniques such as the use of dosett dispenser may be valuable. Problems of communicating with the severely mentally ill about their long-term treatment were discussed.

The paper describes the establishment of a specialist forensic team providing an integrated model of forensic community psychiatric care.

A description is provided of the problems encountered in setting up and running the service and of the ways in which those problems were managed.

The integrated model has the advantage of minimising stigma, providing support and education for staff and enabling forensic expenditure to be provided for a wider group of patients and staff than would otherwise be possible.

The paper describes the first three years experience of a new out-patient eating disorder service for adults. Clinical data on referrals using standardised assessments are presented.

The referral rate rapidly rose to over 200 patients per annum. Forty-nine per cent of referrals were bulimic disorders and 26% had either anorexia nervosa or atypical anorexia nervosa. Seventy per cent were directly referred by general practitioners.

The creation of a specialist eating disorder service quickly leads to a high referral rate suggesting a previously unmet need. A service based on assessment and treatment by nurse therapists is acceptable and feasible with appropriate training and support from psychiatry, clinical psychology and dietetics. Expectations of a specialist service include teaching, consultation, research and audit as well as the provision of direct clinical care.

A questionnaire was used to measure physician satisfaction with the unit and comparison of referral numbers and diagnoses with 1967, when the unit was new, and in 1985 when it was re-audited.

Despite physicians' satisfaction with the service, the referral rate remains unchanged.

Liaison psychiatry should not concern itself with trying to increase referral rates. Research into patient outcome should be a priority and guide its future direction.

We critically appraised clinical guidelines for the use of antidepressants, using an evidence-based approach.

We were unable to identify recent guidelines. The appraisal tool we used failed to identify some of the difficulties now apparent when considering the validity and utility of guidelines.

Critical appraisal tools are useful in providing a framework for assessing published material, but run the risk of blinding us with their simplicity.