All referrals to a psychiatrist from a palliative care unit, during a one year period, were reviewed. The reasons for referral of patients from the unit, the psychiatric diagnosis on assessment, the intervention by the psychiatrist and the results of the intervention are discussed. Depressive illness was the commonest diagnosis in the 26 patients referred (50%). Sudden immobility due to a hemiplegia or paraplegia was noted to be a risk factor for the development of depression (17%). Family factors played a role in the presentation of 14 patients. In the majority of cases intervention by the psychiatrist was in the form of a diagnostic consultation, which led to guidelines for further management by the palliative care team. In four of the cases, intervention by the psychiatrist was more prolonged (greater than three interviews). Forty per cent of the patients referred showed an improvement in their mental state. The conclusion of the paper is that psychiatric assessment can be useful to the palliative care team, in the assessment and management of psychological disorder in patients with a terminal illness.

Four men with HIV infection who were referred to liaison psychiatry for assessment of eating disorders are described. In all four cases the eating disorder had implications for the clinical management of their HIV infection. Investigations of weight loss, dietary intervention, and compliance may all be affected by the presence of an eating disorder. The development of HIV disease may exacerbate the symptoms of an eating disorder.

Working closely with patients who are dying is an anxiety-provoking situation for professional carers. A palliative care unit develops a culture which offers defences to protect its staff against this anxiety. Parallels between the experience of an observer on the ward and the culture of the palliative care unit are drawn, with their implications for clinical work with dying patients.

No abstract

In 1992, Pippard reported a comprehensive audit of electroconvulsive treatment, (ECT), in two NHS regions. He found deficiencies in most aspects of ECT administration (Pippard, 1992), particularly the training and supervision of the administering doctor, usually an SHO or registrar. Regrettably, the competence of a trainee to administer ECT appeared to have improved but little in the 11 years since the same author first reported on the subject (Pippard & Ellam, 1981). In particular, it failed to meet the guidelines issued by the Royal College of Psychiatrists in 1989. This was reflected in inadequate administration of ECT as assessed by direct observation and by determining the provision made for teaching and supervision of ECT by senior staff. Pippard concluded that the overall standard of training was inadequate and that “The responsibility for this mediocrity rests squarely on the consultants as a whole and not just on those whose nomination to be in charge appears to absolve the rest…”.