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Objectives: To determine the attitudes and experiences of nursing staff in relation to violent and aggressive patients.Method: A self-administered questionnaire booklet was distributed to 289 nursing staff working in ‘high-risk’ units within two NHS Trusts. In addition to assessing the frequency of violent incidents, the degree of burnout and post-traumatic symptoms experienced were assessed by the inclusion of two standardised measures in the survey, viz, the Maslach Burnout Inventory and the Impact of Event Scale-Revised respectively.Results: One hundred and fifty six (54%) nurses responded to this survey. Over two-thirds of nurses (72%) had been physically assaulted during the previous two years. The longterm psychological impact of these incidents was not related to whether or not a physical injury was sustained. A positive correlation between burnout and exposure to verbal abuse, threatened assault and violence was demonstrated.Conclusions: Nurses in these Trusts are exposed to an unacceptable level of violence or aggression from patients, potential implications of which include post-traumatic reactions and burnout. However, nurses are reluctant to report incidents of verbal abuse or threats formally, and they rely upon the support of their colleagues following ‘distressing’ incidents. To protect the wellbeing of their staff, hospital management needs to consider preventative measures, such as training and personal alarms, and improved reporting systems to ensure all incidents are accurately recorded.

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The contribution of cholinergic dysfunction to the non-mnestic cognitive impairments associated with senile dementia of the Alzheimer type (SDAT) was investigated. Scopolamine (0 . 5 mg) was administered intravenously to 12 healthy individuals, and their performance on selected subtests of the Wechsler Adult Intelligence Scale Ð Revised (WAIS-R), and on additional non-mnestic neuropsychological tests were compared to that of 12 healthy control participants. The results demonstrate that scopolamine does impair performance on components of the WAIS-R, but that the Fuld WAIS-R pro®le does not have a cholinergic basis. Scopolamine did not impair performance on verbal¯uency, the Token Test, Judgment of Line Orientation, ®nger tapping, the Modi®ed Card Sorting Test, or the Mini-Mental State Examination. The results do not support the hypothesis that the cholinergic system contributes to the non-mnestic impairments in SDAT. #

The psychiatric discharge summary is an important means of communication between general prac titioners (GPs) and psychiatrists and invaluable in the continuity of patient care. The early discharge summary therefore needs to provide relevant information for GPs during this vulnerable period. We surveyed GPs in the Grampian area in order to obtain information felt to be most relevant and the results were incorporated into a new semi-structured format which is now currently being used in the Grampian area.The letter is the main instrument of communi cation between specialists and GPs. The psy chiatric discharge summary is one important aspect of this communication. Craddock (1990) looked at the information contained in the formal discharge letter and concluded that prognosis, advice about management and information given to the patient are often poorly covered, although these items are rated as important by GPs. Craddock & Craddock (1989) also looked at the use of different formats for such a summary and found a discrepancy between the preference of GPs and psychiatrists. Psychiatrists tend to prefer a lengthy summary conforming to the Institute of Psychiatry guidelines, whereas GPs prefer a shorter summary containing pertinent information. Rigby (1988) found that two thirds of GPs were in favour of a semi-structured format with priority being given to diagnosis and prog nosis. It was also felt that this would ensure the inclusion of important items and limit the time and effort spent on less important ones. Orrel & Greenberg (1986) found that 98% of GPs wanted a brief communication of events within two weeks of patients' discharge, but only 26% of GPs received such a service.The psychiatric discharge summary has also been suggested as a useful tool for management and audit (Essex & Doig, 1991). By identifying the local information needs of GPs and incor porating this into a relevant format it was felt that the continuity of care could be improved. This format could also be used to audit various aspects of psychiatric practice and provide infor mation for GPs. psychiatrists and other members of the psychiatric and primary care teams relevant to shared patient care. The studyThe aim of the study was to review the infor mation needs of GPs in the Grampian area in relation to the discharge of psychiatric patients and to design an early discharge summary to meet these requirements. The Grampian area has just over 300 GPs looking after a mixed urban and rural population. The current early discharge summary in the Grampian area is used for all hospital specialties and it was felt that its format could be modified to be more specific to the psychiatric services.A questionnaire was devised incorporating 24 different items that could be included in the summary, as follows.(1) Discharge mental state examination. GPs were then asked to prioritise their infor mation needs. Also included in the questionnaire were questions about the current discharge policy which involves the early discharge sum mary being handed to the GP...