We conducted a survey of the psychotherapy training of a national sample of successful MRCPsych candidates to discover the extent of their psychotherapy training and their opinion about its adequacy. Ninety doctors answered the survey. Overall 71% of trainees had clinical experience in behavioural–cognitive psychotherapy and 78% in psychodynamic psychotherapy with fewer gaining experience in group and family psychotherapies. The majority of trainees were dissatisfied with the extent of their behavioural-cognitive psychotherapy training (82%) and psychodynamic training (50%). Trainees felt that their psychotherapy training was an important component of their psychiatric training.

The pharmacological treatment of depression and the time elapsed since last seen by a doctor were investigated among 507 adults who subsequently killed themselves. The proportion of people consulting a general practitioner or psychiatrist prior to suicide was lower than reported by the British government in the Health of the Nation document. General practitioners prescribed relatively low doses of antidepressants. Nineteen out of the 115 people receiving antidepressants used the drugs to kill themselves. Our findings emphasise the importance of prescribing adequate doses of antidepressants and underline the need for safer prescribing.

There hat boon until recently a dearth of descriptions of locally targeted community mental health services. Such a service, developed by changing a traditional psychiatric service in an inner setting, is described. The service addresses the needs of those with predominantly severe/enduring mental health problems, by increasingly using research based treatments in an ordinary district setting.

The Royal College of Psychiatrists has stressed that psychotherapy skills are seen as a core element of psychiatric practice. To formalise this a new set of guidelines for psychotherapy training as part of general professional psychiatric training was published in November 1993. Concerns have been expressed over the implementation of previous guidelines from 1986. We have surveyed the psychotherapy training experience in our area and have worked with the psychotherapy department to address the findings. The future of training in the psychotherapies and implementation of the most recent guidelines are considered.

Changing methods of recording psychiatric histories by a community mental health team for the elderly was associated with a dramatic improvement in the quality of recording of clinical Information and of communication with general practitioners. Comparison is made with published studies of case note audit with feedback. It is suggested that restructuring the way we work may be more effective than simple review of case notes with feedback.

Detention of general hospital in-patients under Section 5(2) is a rare occurrence. This study of the use of Section 5(2) in general hospitals uncovered a frequent neglect in following the guidelines of The Mental Health Act and The Code of Practice. Surprisingly the conversion rate of Section 5(2) to Section 2 or 3 was similar to that seen in a number of other studies conducted in the quite different setting of large psychiatric hospitals. A number of patient characteristics were identified that appeared to influence whether 5(2)s were converted to an admission Section. Each general hospital needs to develop guidelines to be followed when staff feel that a patient should be detained under Section 5(2) – an example of such a policy is included.

Patients waiting for psychotherapy show high levels of morbidity and distress from psychiatric symptoms and a high frequency of personality disorder diagnoses. They constitute a group at risk of completed suicide. Local NHS provision is less than half the minimum amount of treatment needed.

Prescriptions for psychotropic drugs for in-patients in the Dundee Psychiatric Service were studied for three five-month periods in 1991, 1992 and 1993 using computer data and drug sheets. Information about Journal advertising and advice to doctors was obtained for the same period. A possible effect of Journal advertising was detected in the first year but there was no further Increase in the second year in the total of prescriptions. Information is presented of a similar survey in 1975 and 1976. A high proportion of prescriptions was for formulary drugs and doctors rated the British National Formulary as the strongest influence on their prescribing.

Liaison psychiatry is a relatively new and expanding speciality in the UK. A survey conducted in 1990 revealed widespread inadequacies in the training opportunities and resources in consultation liaison services (Mayou et al, 1990). In spite of a growing recognition of the need for more consultants with designated responsibility for general hospital patients, there is currently no formal training programme and many psychiatric schemes fail to provide satisfactory supervision and training opportunities in liaison psychiatry (House & Creed, 1993). The Manchester University liaison psychiatry course was developed in 1993 and is currently the only advanced liaison training course in the UK. Lasting five days, it provides an opportunity for senior psychiatric trainees to improve their specialist knowledge and to develop clinical, research and management skills in liaison psychiatry. The course does not give a comprehensive review of all aspects of liaison psychiatry but aims to generate ideas and discussion through skills based seminars, case discussion and workshop exercises.

Feigned psychosis, although rare, presents considerable diagnostic problems in clinical psychiatric practice. Long-term follow up data are lacking. A retrospective case note study was undertaken of 10 patients described in a previous paper, published in 1970, on the simulation of psychosis. The computerised diagnostic instrument OPCRIT was applied to both index episode and lifetime occurrence of symptoms. All 10 patients were found to have had a major psychotic illness based on lifetime symptoms at 20 year follow-up by DSM–III–R criteria. Eight had met such criteria at the time of the initial episode. Diagnosis in patients thought to be feigning psychotic symptoms changes over time and major mental illness is likely to emerge which may be schizophrenic or affective. The term feigned psychosis should be abandoned and more attention given to why symptoms are accepted as genuine in some cases but not others.

We have seen many interesting accounts of people's training experiences on the part-time scheme published in this journal, and one or two interesting articles looking at broader related issues, for example looking at attitudes and awareness of part-time training among colleagues and the impact of these factors on recruitment to part-time training.

Psychosis is often associated with Parkinson's disease. The cause of the psychosis cannot usually be confirmed but it may be due to disease progression or, more commonly, to the drugs used in the management of Parkinson's disease.

This paper considers the possible relevance to psychiatry trainees of a period of training in public health medicine. The work of public health doctors is to identify ways of Improving the health of populations and to promote relevant change. It is of relevance to psychiatrists, who have to consider needs of whole catchment populations rather than Just of patients who seek help, and who have historically experienced difficulty in competing for resources. We discuss tasks that trainees might undertake during a brief public health attachment, the potential benefits of such an attachment and some of the practical considerations.

Although there are some well recognised physical disorders such as intracranial lesions that can present with mental illness, many psychiatric conditions do not appear to be associated with underlying somatic complaints. However, a number of recent studies have shown that there are often high rates of concurrent medical conditions among acute psychiatric in-patients that were previously undiagnosed or unsuspected. The author illustrates this point by presenting two case studies in which a significant medical condition was only identified after physical examination on a psychiatric unit.

The Royal College of Psychiatrists' consensus statement suggests that prescribing high dose antipsychotic medication in children and adolescents should rarely be necessary. Our objective was to study the prescribing of antipsychotic medication in a regional adolescent unit during a three-year period. We found that antipsychotic prescribing on this unit is common in psychotic disorders and often high closes are required. This is not in keeping with the recommendations of the consensus statement. Review of clinical practice on other adolescent units is needed, together with a more comprehensive evaluation of the outcome of psychotic disorders in this age group.

‘Drug induced psychosis' is a commonly used clinical label but lacks a universally accepted definition. Psychiatrists' understanding of the term was examined using a specifically designed questionnaire. Knowledge about the effects of drugs of abuse and their relationship with psychosis was also examined. A substantial proportion of clinicians did not have a logical and coherent scheme for understanding ‘drug-induced psychosis' and there was no consensus as to which reactions to drug taking should be included within the rubric. Diagnostic errors have potentially serious consequences, so lack of knowledge in this area needs attention and a proposed classification is given.

This text discusses whether senior trainees should endeavour to Join a College Approval Panel as one of the visiting team, what the advantages would be to the trainees being visited of having a senior trainee representative as a member of the assessing group and what the benefits are to senior trainees in terms of training and broadening their own curriculum vitae.

The closure of large mental hospitals, the move of services into the community and the formation of multi-district rotations have led to a dispersal of trainees onto many sites. This paper seeks to raise awareness of the problems faced by trainees working and training on disposed sites and suggests some solutions. It is the product of discussions within the Collegiate Trainees Committee, the Education Committee and the Psychiatric Tutors Sub-committee.

Despite the apparent advantages of group treatment for parents and their preschool children, this technique is not widely used in child psychiatry departments. Those units that have groups find them useful resources for the assessment and treatment of families with a wide variety of presenting problems. Experience is leading clinicians to run groups that are (a) time limited and closed; and (b) structured and focused in their work. Audit projects are being conducted in some centres to evaluate their usefulness, but no studies have been undertaken of groups using random allocation of patients. This should be done before their efficacy can be assured compared with other treatment models.