Most professions have recently realised that basic undergraduate and postgraduate training is not enough to maintain high standards of practice throughout a long career. Continuing professional development (CPD) has become a feature therefore of the working life of these professions, and medicine, which was in the forefront for undergraduate and postgraduate education, has somewhat lagged behind in this. The failure of consultants to keep up to date in their professional knowledge and attitudes is clearly detrimental to patients, to the doctors themselves, and to the Health Service.

The notion of brief dynamic psychotherapy (BDP) may seem at first sight to be a contradiction in terms. ‘Dynamic’ is a Freudian psychoanalytic term implying conflictual psychological forces — an opposition between the conscious and unconscious mind, and the use of defence mechanisms to arrive at a compromise between them. The rigidity of the obsessional person whose self-expression is traded for security, the self-reproaches of the depressive reflecting inhibited aggression, the clinging of the phobic individual who lacks an inner sense of a secure base — these would be examples of the relationship between dynamic conflict and psychiatric symptoms. But the image of psychoanalysis conjures up a picture of prolonged and intensive couch-based therapy. How can this be brief?

The dopamine hypothesis for the mode of action of antipsychotic drugs has been with us for some 30 years and has, by and large, withstood the test of time. It simply states that antipsychotic drugs owe their therapeutic effects to an ability to block central dopamine receptors. This has given us a working and testable explanation for the effects of these drugs and it has prompted the synthesis of new agents. While so-called antipsychotic drugs (otherwise known as neuroleptics or major tranquillisers) are known to be effective in schizophrenia and related psychoses, mania, and the agitation associated with severe depressive illness or organic disorder, this paper is only concerned with the pharmacotherapy of schizophrenia.

The pharmacological treatment of the elderly differs from that of younger patients, mainly because of altered pharmacokinetics and the higher proportion of patients with organic disorders. We deal here with dementia, delirium, affective disorder, late-life schizophrenia, sleep disturbance, and rapid tranquillisation.