The aim of the audit was to evaluate the current clinical practice for learning-disabled individuals with psychotic disorders. We evaluated the existing clinical practice in 910 individuals who were under the care of learning disability psychiatrists in Buckinghamshire (population of 480 000). This was compared with the National Institute for Clinical Excellence (NICE) published guidelines on treatment and management of schizophrenia. Twenty-eight per cent of the patients had a dual diagnosis of psychosis and learning disability; 40% showed moderately severe psychotic symptoms. Oral atypical antipsychotics were the preferred medication of choice. Twenty-five per cent of the patients were found to be treatment resistant. All patients received medication within the recommended doses in the British National Formulary. This audit highlights the varied presentation in our client group. In view of the diagnostic difficulties often encountered in patients with learning disabilities and psychosis, the authors feel that it would be helpful to supplement clinical assessments with the use of a symptom rating checklist/scale in diagnosis and monitoring the course of psychosis. We propose a checklist that could be used in routine clinical practice to record clinical symptoms and drug-related side effects.