This short Act, which amends some parts of the Criminal Procedure (Insanity) Act 1964, came into force on 1 January 1992. It applies only to cases where arraignment was after that date (start of trial when charge[s] is read to the defendant), and only in the Crown and higher Courts. It enables Courts to try the facts of a case even when the defendant is “Under Disability” (= Unfit to Plead) and, when finding a person “Under Disability” or “Not Guilty by Reason of Insanity”, to order other disposals than indefinite detention in hospital. The legal definitions remain unchanged.

In the light of proposals to change the system of providing NHS health care, it is important for future district or regional procurers to have reliable data on which to base their treatment ‘contracts’, bearing in mind not only current but also the potential demand of a mature market.

The District Services Centre of the Maudsley Hospital deals with the care and rehabilitation of people with chronic mental illnesses. Three independent teams of mental health professionals comprise nurses, occupational therapists, psychiatrists, psychologists, and social workers. A multidisciplinary team approach is used in the assessment and management of patients. Most of the patients are either day-patients or ‘supportive’ patients who attend less frequently. The service is thus very much community based and orientated, and the support and involvement of close relatives in the care of the patients is seen as both necessary and desirable.

Testing the ability to write a simple sentence has long formed part of the clinical assessment of the cognitive state in the elderly, and has even been incorporated into standard brief cognitive tests (Folstein et al, 1975). Writing a sentence tests a number of faculties including language skills and praxis. As part of a comparative study of four tests of cognitive function—the Felix Post Unit (Institute of Psychiatry, 1987), Mini Mental State Examination (Folstein et al, 1975), Abbreviated Mental Test (Qureshi & Hodkinson, 1974) and Medical Research Council (MRC, 1987) – sentences written by 158 elderly newly admitted psychiatric patients, as requested in the Mini Mental State, were collected. Our aims were to assess the value of sentence-writing in discriminating between dementia and depression, and to compare the style and content of what was written. Would the material chosen by the patients for their sentences be associated with their diagnoses? In particular, would depressives write miserable sentences and the demented be more likely to write nonsense?

The title seems chosen to catch the eye. This it does, but as being perjorative. In contemporary writing about sexual variations only psychoanalysts and a few psychotherapists retain the term ‘perversion’; others have abandoned it as stigmatising.

There has been much discussion on the most suitable services for mentally handicapped people with special needs such as additional mental illness or marked behavioural disorders. A number of policy documents have advocated the use of generic services as a matter of course, such as the All Wales Strategy (1983), while others have acknowledged a possible need for specialist input when such services are used e.g. Needs and Responses (Department of Health, 1989). In 1986 the Royal College of Psychiatrists stated that the psychiatric needs of this group required a specialised service and suggested that ideally this would be integrated with other psychiatric specialities as part of a comprehensive service.

Recent guidelines recommend that where appropriate, procedures for the development of audit in medicine and professions allied to medicine can be replaced by comprehensive multidisciplinary audit of services. The Royal College of Psychiatrists (1990) suggests that clinical audit, involving the work of other staff in the multidisciplinary team, is preferable to purely medical audit. Given the importance of team work in child psychiatry, it seems appropriate to establish a system of audit which enables all disciplines to be involved.

In an era where computerised information is dominant, it may seem an eccentric enterprise to assess the quality of case-notes and to propose changes in the notekeeping process. There are no institutional incentives for clinicians to provide organised and standardised clinical notes (Casper, 1987) and there is no clear evidence that poor notekeeping means that satisfactory care has not been provided.

Recent changes in psychiatric services have produced a movement away from large hospitals to management within the community. A successful home treatment service with 24-hour cover has been described for severe acute psychiatric illness, though hospital admission was not entirely avoided (Dean et al, 1990). It is difficult to manage violent patients or those who will not comply with medication at home. If relatives are not supportive hospital admission will be required. Although living alone is not a contraindication to treatment at home, those who require constant supervision because they are, for example, suicidal need to be admitted. Concurrent physical problems may also necessitate hospital admission. Any future services must therefore include some in-patient care.

When Britain committed an armoured division to the Gulf in the autumn of 1990, it was inevitable that psychiatrists and other mental health personnel would be required. Battleshock, or combat stress, is important to the Army – it not only accounts for significant numbers of casualties in any land war, but, unlike other casualties, represents a potentially avoidable loss of manpower and important source of reinforcement. Based largely on the experience of Arab-Israeli conflicts it is believed that, with appropriate management, up to 90% of battleshock cases can be returned to duty within seven days. Moreover, it is thought that early recognition and intervention may reduce the incidence of PTSD and other long-term psychiatric sequelae (Foy et al 1987; Solomon & Benbenishty, 1986). Fortunately, Battleshock claimed few victims in the Gulf, due mainly to the brevity of the land war and the high state of motivation and morale of the allied force. The effectiveness of the Army's policy of early recognition of battleshock cases with minimal medical intervention on the battlefield and rapid return to duty remains uncertain and untested (Dunning, 1990).

Following the recommendations of the Butler Report (Home Office, 1975), there has been a slow growth in the number of Regional Secure Units (RSUs) (Snowden, 1985), which aim to assess and treat mentally disordered offenders in England and Wales in conditions of “medium security”. One particular recommendation of the Butler Report was that:

“The main emphasis in forensic psychiatric services … should be on community care and out-patient work.” (paragraph 20.14)

Alzheimer's disease (AD) is the commonest form of dementia and affects about 6% of people over the age of 65. The aetiology is unknown and putative causes range from environmental toxins (Martyn et al, 1989) to chromosome abnormalities (St George Hyslop et al, 1987). Despite the extensive resources being channelled into AD research, it is surprising that no study has yet discussed the role of false teeth.