Antidepressants are increasingly being used for the treatment of anxiety disorders, although they are not specifically licensed for this indication. This has come about partly because of concern over the problem of benzodiazepine dependence and the search for alternative, and preferably better, treatments. Antidepressants and other treatments have proved to be an effective alternative to benzodiazepines despite having more unwanted effects and a delayed onset of action. They may even be more effective than benzodiazepines and their benefits are alleged to be independent of concurrent depressive symptomatology. What is the evidence in favour of these claims?

Withdrawal of chronic day-time users from benzodiazepines is rarely attempted in general practice because patients are considered more dependent on their medication than analogous night-time users. Our aim was to evaluate two forms of brief intervention by general practitioners to reduce intake of benzodiazepines in chronic day-time users. A subsidiary aim was the development of a booklet to help patients with benzodiazepine withdrawal.

There is currently considerable debate in the UK as to the preferred model of services for adults with an acute mental health problem. Most of this debate has focused on the apparent benefits of the various models. Little research has been undertaken, however, on the financial costs of the models. This paper attempts to present some initial costs for both innovative and standard models of service. It is intended to generate thought about the scale and nature of the financial costs entailed in different models of service.

Much of the medical care of the long-term mentally ill falls to the general practitioner (Wilkinson et al, 1985) and, for example, a survey in Buckinghamshire showed that these patients consult their general practitioner (GP) twice as often as mental health services. Lodging house dwellers are known to show an increased prevalence of major mental illness and to suffer much secondary social handicap, presenting a challenge to helping services of all disciplines. For this reason we chose a lodging house in which to explore further the relationships between mental illness and residents' present contact with their GP, mental health services and other local sources of help.

Following the introduction of a 24 hour Emergency Clinic at the Maudsley Hospital in 1952, psychiatric hospitals across the UK have come to offer a similar but often smaller service.

Many mental disorders are associated with an increased risk of fire setting. As a result, its assessment and management is an important part of the management of people with psychiatric disorders. As more patients are managed in the community, away from the protection of high levels of hospital staff and fire regulations, such assessments are vital to ensure appropriate and safe placement. The presence of fire regulations in hostels offers only limited protection. Further, as residences with four people or less are not subject to fire regulations, assessment by psychiatric staff may have to extend to the fabric of the placement. Despite psychiatric hostels tending not to accept patients who are ‘a fire risk’, figures suggest that fires in hostels are common. One health authority reported 26 fires in hostels over 12 months (Moxom, personal communication).

The responsibility for patient treatment is shifting from physician to non-physician professionals throughout medicine. Multidisciplinary teams are replacing hierarchical structures in which the consultant is dominant, particularly in disciplines which care for patients suffering from multiple or chronic disabilities.

Medical audit has become an overt part of our work over the last few years, hastened by the 1989 White Paper. At a meeting on 1 November 1989, the mental handicap psychiatrists of Bristol and Weston, Cheltenham, Frenchay, Gloucester, and Southmead Health Authorities agreed to meet monthly to audit agreed topics in mental handicap across district boundaries. These meetings were to be in addition to any local district audit that may already have been occurring, and were to provide a peer group for audit and a means of cross-fertilisation of ideas for projects. The group has now operated for over two years, and would like to present some examples of the topics covered and some comments on its experiences to help stimulate correspondence in the Psychiatric Bulletin on medical audit in learning disabilities.

Postgraduate psychiatric training is usually assessed by regular College visits. A number of training schemes, including the Liverpool training scheme, also scrutinise their training independently of the College. As far as we know, trainees as the ‘consumers’ of training have never assessed its quality themselves. The following account deals with two such audits in the Mersey region organised under the mantle of the Association of Liverpool Psychiatrists in Training (ALPIT).

It is generally agreed that training in liaison psychiatry should be available at SHO/registrar grade, but the College's guidelines are not specific about what it might entail. As a result it is difficult for approval visitors to decide whether a particular post on a rotational training scheme truly provides liaison experience. At times so-called “liaison experience” amounts to no more than participation in a duty-rota for visiting a general hospital to undertake the assessment of cases of deliberate self-harm.

“I am superior in many ways but would gladly give it up to be human.”

Lieutenant-Commander Data – on android and serving officer on the Starship Enterprise Circa the 25th century at Encounter Farpoint. (See Fig. 1).

Striking advances in artificial intelligence (AI) have brought to life philosophical debates about the concept of the mind, and of consciousness. Strong advocates of AI suggest the symbiosis of man and computers is the next step in our evolution, and to control this process, we need to address the “Big Question”: what is the meaning of life, and specifically, what are we? Understanding what we are is of great interest to us all; for psychiatrists, philosophers, and psychologists it is their life's work. In this paper, I shall introduce some of the main ideas about AI under the following headings. Can computers have a mind, improve our understanding of, or be integrated with our mental processes?

Despite the increased availability of psychotherapy within the NHS, inequalities remain (Holmes & Lindley, 1989). Traditionally, psychotherapy services have been provided from teaching centres in cities and patients have had to travel for treatment. This may account in part for the middle-class predominance in psychotherapy patients and Holmes (1991) has identified the need for psychotherapists to reach out and cater for the disadvantaged in large housing estates and rural areas. While services are changing to meet such needs (Pedder, 1989) there are powerful economic restrictions on service expansion. The potential for communications technology such as interactive television to aid the delivery of general psychiatric services has been reviewed by McLaren et al (1992) and similar arguments apply to the delivery of psychotherapy.