AIMS AND METHODTo study the attitudes and opinions of doctors and medical students with regard to psychiatric illness a questionnaire was sent to all medical students (832) and all doctors of all grades (441) at a London teaching hospital.RESULTSA total of 520 questionnaires were returned. More than 50% felt that people with schizophrenia and drug and alcohol addiction were dangerous and unpredictable. It was felt by the majority that people were not to blame for their conditions and there were low negative responses towards lack of treatability for a majority of conditions.CLINICAL IMPLICATIONSThere were more optimistic views with regard to treatment than the general population. There appeared to be a lessening in stigma as experience increased. This would suggest that early improved education and exposure in the future may lead to a greater decline in stigmatised attitudes.

Smoking is the largest single cause of preventable illness in the UK. Those with mental health problems smoke significantly more and are therefore at greater risk. The new Health Act (2006) will require mental health facilities in England to be completely smoke-free by 1st July 2008. This article reviews the current literature regarding how smoking affects both the physical and mental well-being of people with mental health problems. It also considers the effects of smoke-free policy in mental health settings.Jonathan Campion is a specialist psychiatry registrar on the St George's Psychiatry Training Scheme in London

Aim: To develop and evaluate the comparative effectiveness of behavioural interventions of enhanced prevention counselling (EPC) and simple educational counselling (SEC) in reducing hepatitis C viral (HCV) infection in sero-negative injecting drug users (IDU). Design: Randomised controlled trial (RCT) of EPC intervention in comparison with simple educational counselling (SEC).Setting Specialised: Drug services in London and Surrey, United Kingdom. Participants and Measurements:Ninety five IDUs were recruited and randomised to receive EPC (n = 43) or SEC (n = 52). Subjects were assessed at baseline using the Addiction Severity Index (ASI), the Injecting Risk Questionnaire (IRQ), and Drug Injecting Confidence Questionnaire (DICQ). The primary outcome was measured by the rate of sero-conversion at 6 months and 12 months from baseline and by the ASI, IRQ and DICQ at 6 months from baseline. Hepatitis C testing was undertaken by the innovative test of the dried blood spot (DBS) test which increased the rate of testing by 4 fold compared to routine blood testing.Findings Seventy: Eighty two subjects (82%) out of the 95 recruited were followed up at 6 months and 62 (65%) were followed up at 12 months. On the primary outcome measure of the rate of seroconversion, 8 out of 62 patients followed-up at twelve months seroconverted, three in the EPC group and five in the SEC group, indicating incidence rates of 9.1 per 100 person years for the EPC group, 17.2 per 100 person years for the SEC group, and 12.9 per 100 person years for the cohort as a whole. Analysis of the secondary outcome measures on alcohol use, risk behaviour, psychological measures, quality of life, showed no significant differences between the EPC and the SEC groups. However, there were significant changes on a number of measures from baseline values indicating positive change for both groups. Conclusion:We were not able to prove the efficacy of EPC in comparison with SEC in the prevention of hepatitis C in IDUs. This was related to low recruitment and retention rates of the participants. Moreover there was a low adherence rate to EPC. The study provided the benefits of developing and introducing behavioural interventions of the EPC and SEC and the DBS screening for Hepatitis C. Moreover the main lessons learnt were that piloting of a new intervention is a crucial first step before conducting pragmatic RCTs of psychological interventions in the field of addiction; that an infrastructure and culture for psychosocial interventions is needed to enable applied research in the service environment, and research funding is needed for enabling the recruitment of dedicated trained therapists for the delivery of these interventions.

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This article reviews the current literature regarding treatments for smoking cessation in both the general population and in those with mental health problems. The gold-standard treatment for the general population is pharmacotherapy (nicotine replacement therapy, bupropion or varenicline) coupled with individual or group psychological support. This is also effective in helping people with mental illness to reduce or quit smoking, but care must be taken to avoid adverse medication interactions and to monitor antipsychotic medication in particular as cigarette consumption reduces.Jonathan Campion is a specialist psychiatry registrar on the St George's Psychiatry Training Scheme in London

Aim: This study looks at changes in the knowledge of and attitudes towards substance misuse in medical students in two UK medical schools between years 1 and 4 of undergraduate training. Method: The instrument used comprised 20 questions regarding knowledge, attitudes to training, clinical practice, and stigma. Questionnaires were distributed to 1st and 4th year students. Data was entered onto Microsoft Excel worksheets and analysed using the Excel program. Results: There was an overall response rate of 75%. Knowledge was poor amongst the students, with little improvement seen between 1st and 4th years. Responses to attitudes to training were encouraging from both years of students at both schools. Attitudes to clinical practice demonstrate improvement between the 1st and 4th years. Negative attitudes to substance misuse greatly diminish from the 1st year to the 4th. Conclusions: Education and training in substance misuse are vital in the personal and professional development of medical students, who will become tomorrow's doctors. This study indicates that, while there is a degree of improvement in their knowledge about prevalence and complications related to substance misuse, there is a more clear cut change in attitudes to substance misusers and the value of treatment, as students progress through their years of training. However, an unacceptably high proportion of students still feel negatively about the patient population and about treatment prospects and prognosis.

The high rates of sexual abuse and its association with indications of increased morbidity suggest it is an important issue for the management of alcohol problems. More use could be made of self-completion questionnaires for the investigation of sexual abuse.

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