Wilson's disease (WD) is an autosomal recessive disorder of copper metabolism with an incidence of about 30 per million (i.e. fewer than 2,000 in the UK). Nevertheless, it is important for two main reasons: its manifestations are protean and may lead it to present to a range of specialists; and its otherwise lethal course can be halted by treatment with chelating agents such as penicillamine and trientine. Published cases and systematic study have shown that neuropsychiatric symptomatology is important in a high proportion. In fact, about one-fifth either present psychiatrically or are at least seen by a psychiatrist before WD is diagnosed.

It might at first sight appear that old age psychiatrists and geriatricians are relatively well protected from having to deal with the problems of patients suffering from the Acquired Immune Deficiency Syndrome (AIDS). It is therefore perhaps surprising that the major article in the newsletter of the American Geriatric Society is devoted to AIDS and concludes that “there is no question that the AIDS epidemic is the most important world wide public health issue of this century”.

Many junior doctors, some with only undergraduate training, will this August feel at the pointed end of psychiatry when they are asked to see an ‘overdose’. The referral letter is unlikely to be more specific concerning what service they are to render to the patient or the referring physician. In the psychiatric textbooks the tyro will find a wealth of actuarial data but little clinical advice. After four years as a junior psychiatrist I present a personal philosophy of what one is doing when one assesses the survivor of a (para) suicidal act.

Several authors have written articles giving advice from the examiners' standpoint regarding the Membership examination in psychiatry but surprisingly little has been written by those with recent first-hand knowledge of the examination. Having failed the examination on my first attempt due to poor technique, I feel other candidates should be made aware of some possible pitfalls which they may encounter. Examinations, unfortunately, do not always necessarily examine that which they purport to examine. I also feel that some useful tips, which may make the examinee's task an easier one, should be passed on.

The Joint Committee on Higher Psychiatric Training (JCHPT) requires senior registrars (SRs) training for special responsibility posts in old age psychiatry to spend between one year and 18 months in higher training posts in which psychiatry of old age forms the major part of the work. Although only about a third of consultants in a recent survey had such training, there was strong evidence that more recently appointed consultants were likely to have recommended training. The availability of suitable training ‘slots’ seems likely to play a major role in how quickly specialised psychiatric services for old people can develop in response to the rising challenge posed by demographic changes. Jolley has already demonstrated how developments have been delayed by a shortage of properly trained candidates. Despite this the situation has now been reached where over two-thirds of the elderly population of the UK are served by specialised consultants albeit sometimes at inadequate manpower levels.

With the process of closing psychiatric hospitals and establishing community-based alternatives more than 20 years old in the United States, psychiatric practice there is in the post-deinstitutionalisation age. In Britain we are now starting on this same path. Against this background, I attended the annual conference convened by the journal Hospital and Community Psychiatry in October 1987. Held in Boston, in the same week that Major Koch of New York sanctioned the compulsory reinstitutionalisation of homeless mentally ill people from the streets of Manhattan, the conference emphasised four themes: homelessness, outreach programmes, systems of case management, and compulsory out-patient treatment.

Psychiatric services for the elderly are evolving rapidly. The Government has recently reiterated that this area needs special attention. The reasons for upheaval are well-known: the changing age structure of the population, the historical neglect of the elderly mentally ill and a growing emphasis on community-based approaches in place of traditional institutional solutions. In the London area and elsewhere, adjustment has been complicated by geographical transplantation from old suburban mental hospitals to locally situated units, often within district general hospitals. New specialist services also suffer from the effects of financial stringency and inadequate recruitment. These and other changes have ensured that the process of restructuring services has been difficult. Planners have had few precedents to fall back on, and have been heavily dependent on available guidelines. There has been comparatively little information available about how effectively services work in practice.