Clinical Practice Guidelines (CPGs) are systematically developed statements to assist practitioner and patient in clinical decisions about appropriate health care for specific clinical circumstances. The Royal College of Psychiatrists CPG Programme aims to develop clinical guidelines which are scientifically valid and acceptable to those affected by them. At the same time, CPGs must be responsive to advances in knowledge, and versatile enough for the demands of routine practice. Their development involves a number of stages and a variety of methods, built into a cycle of evaluation and review. The Programme has established priorities for clinical topics for CPG development through consultation with the mental health community. Well-developed CPGs would benefit clinicians, patients and purchasers of care. It Is now important to appraise their ability to change clinical practice, the associated direct and indirect costs, and their value as a medical technology. The clinical professions are in the strongest position to co-ordinate their development, and guide their evaluation.

To avoid identifying patients with a class while classifying disorders, DSM-IV specifies that it will not use such expressions as a schizophrenic but instead will use the designation an Individual with schizophrenia. This review aims to explore the sociolinguistic connotations of various designations used for patients suffering from schizophrenia. An analysis of these designations from six perspectives, using conceptually different sociolinguistic paradigms, systematically supports the DSM-IV comment. Further research is required into the social impact of the language of psychiatry.

The British benefit system provides for disabled people. However, disincentives within the existing system reduce uptake of benefit entitlements. The link between mental illness and poverty is now well known. If welfare benefits are essential for mentally ill people to function effectively in the community, then changes may be necessary to the current system. These changes include increasing the availability of accessible literature and information from both health and social services sources, further training for mental health staff, and the automatic evaluation of benefit entitlement by the Department of Social Security.

Patients seen in psychiatric settings may, for a variety of reasons, be incapable of informed consent. The Mental Health Act allows for their treatment, but research into their pathologies is practically impaired (while their consent is a criterion for inclusion). Is it ethically unacceptable to perform research upon these patients? If so, then the prospects for therapeutic and conceptual advance seem remote. In this paper the competing ethical claims are examined. An approach is proposed which is humane yet permissive of research in this heterogeneous group of patients.

Three hundred randomly selected fund-holding general practitioners were sent a questionnaire that asked them to indicate their priorities for child mental hearth services. They were also asked to rate their local child mental health services; 210 (70%) returned completed questionnaires. Items accorded the highest priority by the largest number of GPs included written communication, short waiting time following referral, sensitivity to patient's cultural background, child sexual abuse services, and mental handicap services. Child psychiatrists were seen as the most essential members of multidisciplinary teams, and family therapy was the most popular choice of treatment. Financial considerations did not appear to dictate GPs' choices. About half of respondents rated their local services as barely satisfactory, unsatisfactory or extremely unsatisfactory.

An unstructured observation concerning low rates of observed psychological disturbance was explored by estimating rates of suicide, and psychotropic drug use. Recorded suicide, overdose, and ‘minor’ tranquilliser and antidepressant use were strikingly low on Tobago, when compared with the United Kingdom. Tobagonians were unlikely to medicalise distress by presenting with overt psychological symptoms. Most local doctors felt that patients preferred spiritual support, e.g. from charismatic religious groups and traditional healers (some using obeah). A rich network of social and recreational groups may also give important support, as may ‘liming’ (a local conversational pastime). Tabanka (a local culture specific syndrome) may also be a non-medical outlet.

Mental health promotion clinic funding was introduced with the new general practice 1990 contract and has been extensively used to fund counsellors and stress management clinics in primary care. This funding has been withdrawn. A postal survey was conducted on all 142 general practices in East Sussex in order to assess the impact of the introduction and withdrawal of mental health promotion clinic funding on the employment of counsellors and on stress management clinics. One hundred and forty practices participated and it was found that there was an increase from 33 to 70 counsellors employed and five to 36 stress management clinics run by January 1993. Many GPs did not know what would happen to their service and it was estimated that 44 (63%) of counsellors and 13 (36%) stress management clinics would be lost.

If psychoanalytic psychotherapy is to be part of the undergraduate medical curriculum, it must be well taught, and demonstrably relevant to the training of doctors. Psychotherapy teachers have a responsibility to devise a syllabus which is clear and relevant and to provide teaching which stimulates and engages the students so that they learn by thinking and understanding. An outline of a syllabus for medical students is included and one seminar as an illustration of interactive learning is described.

One of the few joys of moving house, is the rediscovery of books you haven't opened for years. I was sitting among the dust-sheets rereading Francis Wyndham's anthology of criticism (Wyndham, 1991), when I came across his description of the erstwhile Blue Angel going through yet another reincarnation on the stage of the Queen's Theatre in 1973.

The launch of the All Wales Strategy for people with learning disabilities in 1983 heralded an era of redressing the anomaly of 80% of resources being deployed in hospitals while the majority of people with learning disabilities lived at home (Welsh Office, 1983). Social services were given the lead responsibility to plan and co-ordinate services away from institutions towards community based facilities. In 1983, some 2,100 people with a learning disability were resident in hospitals and hostels; by April 1991 the number had fallen to just over 1,300. There was a concomitant development of services in the community with a rise in the number of adults living in ordinary accommodation from 170 to 1,000. The priorities for development of services in the second phase of the strategy were set out in the ‘Framework for Development’ from April 1992 (Welsh Office, 1993).

In December 1994 Lahore was host to an international psychiatric conference with participants from various countries including Pakistan, UK, France, Denmark, Belgium, Germany, Kuwait, Qatar, Saudi Arabia, Belarus, USA, Canada and Australia. The main contingent of foreign delegates of about 40 consultants was from the UK.

There are only 130 psychiatrists in Pakistan for a population of 95 million and they are stationed at major cities where only 15% of the population of the country resides. The foreign trained psychiatrists, mostly in the UK, are attached to the departments of psychiatry of medical schools in major cities and are not willing to go to rural areas where 85% of the population lives. Thus there is an acute shortage of psychiatrists at district headquarter hospitals (DHQ) in rural areas.