It was our objective to compare the influence of patients' variables and circumstances of admission on the use of observation levels in acute psychiatric admissions in a British mental health unit. We performed a prospective case note survey of all acute psychiatric admissions during 28 consecutive days in June and July 1991 within a large teaching hospital and a traditional psychiatric hospital in Nottingham, England. We compared, the demographic characteristics of 88 consecutive admissions, admission procedures, clinical data, initial observation levels and changes in observation levels. As for the results, most patients were admitted outside of regular working hours (weekends or after 5 p.m.). Most patients were placed on intermediate (close) observation. The most important factor associated with the choice of observation level was the legal status of the patient (chi2 = 14.79, df = 2, p< 0.001, Fisher's exact test p < 0.0001). There were significantly fewer incidents (chi2 = 7.72, df= 2, p < 0.05, Fisher's exact test p < 0.01) on the highest (special) category of observation. The observation policy of the unit was not followed consistently. The number of factors contributing to the choice of observation levels reflects the complexity of the task facing the staff. Special observation is an effective method of managing acutely disturbed patients. The time of admission of most patients implies that more trained staff should be provided outside of regular hours. Clinical staff should be regularly trained in the use of observation procedures. It should be a regular topic in clinical audit.

Objective: Examination of the process of therapeutic observation, as performed by nursing staff on acute assessment wards, from the perspective of adult inpatients.Method: One week after admission, patients were asked to complete a questionnaire, enquiring whether they had noticed their observation, and the extent to which they found it intrusive. Diagnoses were categorised by ICD–9, from the case-notes. Chi-square was used to analyse the results.Results: Fifty six per cent of patients perceived changes in the intensity of their observation. Psychotic patients were significantly more likely than the rest (p = 0.016) to feel that they were observed too closely, despite not being uncomfortable with this. There was a trend for patients in the traditional psychiatric hospital to feel more discomfort than those on a psychiatric ward in the district general hospital (p = 0.12).Conclusion: Respect for privacy and dignity may notentirely be attainable for the most vulnerable group of psychotic patients. Opportunities may exist to improve matters with the closure of asylums and attention to ward layout and design.

This project confirmed the existence of a high preva lence of thyroid disorders among people with Down's syndrome. Fourteen out of the 69 subjects (20%) had hypothyroidism, and a further seven (10%) had subclinical hypothyroidism, while there was one definite and one sub-clinical hyperthyroidism. A sex differ ence was noted, with 12of the 25 females (48%) and 9 of the 44 males (20%) having clinical or sub-clinical hypothyroidism, while the two cases of hyperthy roidism were male. Thyroid disorder was sufficiently commonly found to make a regular review both of the thyroid function tests and medication worth while. Although this system was devised for use with Suresh and Robertson a group of in-patients, it could be adapted for use with people with Down's syndrome living in the community.

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One third of hospital emergency admissions were due to ADEs, and these were associated with the same factors found in other studies (number of drugs consumed, female sex, age and social background). In addition, we observed that ADEs are predominant in patients with low values on the health practices index, and in those with underlying illnesses.