Complaints of delays at out-patient clinics are common; a Newham patient's complaint that she had not been kept waiting long enough was correspondingly puzzling but has subsequently proved very fruitful. Her explanation that discussions with other waiting patients and the OPD nurse were often more helpful than the interview with the doctor triggered the development of a clinic designed for fuller participation of patients and staff.

The above specimen MRCPsych Part 1 question (Royal College of Psychiatrists, 1989) illustrates well the difficulties facing the examination candidate who is required to make a TRUE/FALSE/DON'T KNOW decision in the knowledge that an incorrect response will result in a negative mark.

The Huddersfield crisis intervention team began crisis intervention work after visiting well-established crisis intervention centres and reviewing the literature. In Huddersfield health district there are four adult psychiatrists, each covering a sector of about 54,000 population. At the time of the establishment of the crisis team, the health district was not sectorised. Since 1 February 1989 the district has been sectorised into four parts and the Huddersfield Crisis Intervention Team covers the Huddersfield West Sector

On several occasions in the last ten years, when interviewed by a market researcher about future developments in the treatment of schizophrenia, we have said that the biggest problem in the drug management of schizophrenia is compliance. We believed that if drug companies could manufacture an injectable neuroleptic lasting six months, then many of our problems would be over. Compared with this, the benefits of a new neuroleptic preparation appeared to be trivial.

Is it reasonable for mentally ill people to “do nothing”? At a recent meeting of the Social, Community and Rehabilitation Section of the College, there was some discussion of this in the context of the influential ‘Three Hospitals’ study. The assumption of those researchers had been to view such non-activity in a pejorative light. Some members of the audience considered this simply reflected the “class norms and value preferences of the professionals”, a phrase used by Jones et al in relation to modern attitudes towards community care. Developing a thoughtful and historical perspective, based on their own continuing work in the Friern/Claybury TAPS (Team for Assessment of Psychiatric Services) research project, these authors have highlighted several key weaknesses of the modern non-asylum movement.

Clozapine is an atypical antipsychotic drug with relatively weak D2 and D1 blocking properties and strong 5HT and cholinergic blockade. Its potency as an antipsychotic drug is surprising considering the ratio of receptor blockade and it represents a true advance in treatment of schizophrenia. The efficacy of clozapine calls for revision of the seemingly over simplistic dopamine theory of schizophrenia. Now clozapine is available in the UK to consultant psychiatrists who register with the Clozaril Patient Monitoring Service (CPMS).

Medical audit has been defined as the systematic, critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources, and the resulting outcome and quality of life for the patients (Department of Health, 1989). The medical profession has been under pressure to extend and improve audit procedures in recent years (McKee et al, 1989), but there have been doubts about the most satisfactory methods, particularly in psychiatry (Garden & Oyebode, 1989). There are numerous methodological problems in measuring the outcome of psychosocial care (Shaw, 1989; Royal College of Psychiatrists, 1989). Indicators of outcome which have been used in medicine include incidence of adverse events. Reintervention rates do offer some measure of outcome, and have been used widely in other medical specialities.

In the wake of legislation overseas, Western Australia promulgated a new Mental Health Act in 1966, paving the way for the establishment of private psychiatric hostels in the community and the discharge from mental hospitals of many chronically ill, long-stay patients.

Among other things, good medical practice demands continuation of training at every level of professional life. Post-membership psychiatrists who have started their senior registrar (SR) jobs may face a lack of formal training. In many subspecialities of psychiatry this has been extensively remedied by various training courses and programmes.

Careers in academic psychiatry can follow various paths but usually are aimed at achieving a university appointment at consultant grade; i.e. senior lecturer, reader, or professor.

The West Midlands Senior Registrar Rotational Training Scheme in General and Geriatric Medicine has established links with the Senior Registrars in Psychiatry of the Elderly and their trainers. Reciprocal attachments to one another's specialty are encouraged and expected, much along the lines of the Royal College of Psychiatrists and British Geriatrics Society recommendations. This has been gratifyingly successful: the attachments have proved very satisfactory in themselves and have led to joint research and to friendships, some of which may form the basis of harmonious and constructive working relationships in years to come.

Forensic psychiatry is a relatively new subspeciality concerned with giving advice on, and with the assessment and treatment of, mentally abnormal offenders. The forensic psychiatrist works at the interface between psychiatry and the law.

Present guidelines for the prescribing of antidepressant medication, with particular reference to the duration of treatment, are unclear (BNF, 1989). Evidence suggests that continuation of treatment for at least six months is valuable in the prevention of relapse of the acute illness (Mindham et al, 1975). Other workers have demonstrated a prophylactic effect similar to lithium over a three year period in patients with unipolar depression. There is, however, a paucity of information about the benefits (or lack of benefits) of longer term maintenance treatment. This study focuses on a population of a type which has been previously studied elsewhere – of patients in general practice receiving long-term (greater than one year) antidepressant medication. The implications of this to the psychiatrist and general practice–psychiatry liaison are discussed.

The purpose of this paper is to examine existing information technology (IT) options for child and adolescent psychiatry (CAP) and to propose a strategy for continuing developments in the light of current NHS policy and priorities. It is the outcome of discussions among a group of colleagues within the South West Thames Association for Child and Adolescent Psychiatry. I offer it for discussion as the issues facing us have obvious wider relevance to the profession. The case for investment in health care IT systems has been made most recently in Working Paper 11: Framework for Information Systems (HMSO, 1989). The priorities spelled out in the paper are for management of contracts, measurement of quality of care, costing of services and management of resources.

Trainees in psychiatry are encouraged to become involved in research during their training (Sims, 1988). As Crisp (1990) points out, research skills are basic to a number of attributes such as problem solving abilities, consultation skills, self-audit, and the audit of others. Both the College and senior registrar appointment committees seem to value some research experience as it demands persistence, as well as the ability to think both creatively and logically. The College does provide a research option for the MRCPsych Part II, but this is only chosen by a minority of candidates. In addition the College runs its own course. Nevertheless, many trainees find it very difficult to know how to set about research unless they have previous experience or their job specifically involves research.

The early years of medical students' experience can clearly be important in shaping their attitudes for the future. Typically pre-clinical students are bombarded with basic science subjects and many express the view that it is difficult to see the relevance of much of their academic study to their ambition of working with people. The Behavioural Science Course which is generally held during the students' second year is one of the few courses which is devoted to the functioning of the whole person in society. Typically, this course includes psychology and medical sociology.

Council agreed to sponsor the Registrar on a visit to Romania to join a team from the Wolfson Centre, Great Ormond Street, and the Newcomen Clinic at Guy's Hospital. The main focus was the Neuropsychiatric Children's Hospital at Lugos in the region of Banat in Western Romania. The Director of this hospital had asked for this visit.

The new syllabus for both general and psychiatric nurses, Project 2000, is a manifestation of the gradual revolution taking place in nursing. It attempts to address some long-standing issues which have concerned the profession in several countries. The resolution of these issues will determine the role of nurses as members of the multidisciplinary team and effect cooperation and interactions therein.

There is an increasingly large population of those who are chronically disabled as the result of brain injury (Jennett & Macmillan, 1981). These injuries can be the result of trauma, infections, tumours, hypoglycemia, anoxia or other damaging conditions. The large majority of rehabilitation units cater for physical problems only. However, it has been recognised that patients with brain injury often develop behavioural disorders during the early recovery phase and in a few cases these persist (Eames & Wood, 1989).

The Code of Practice for the Mental Health Act, 1983 “has now passed through the necessary Parliamentary procedure” but may still be subject to amendment by Parliament, and in this context it is useful to consider the expressed intention of Parliament over the last 70 years in relation to short term treatment orders and the Code's current guidance on S.2 of the Mental Health Act 1983.