We studied a series of twins systematically ascertained through 214 probands (84 monozygotic, 130 dizygotic) who had had one or more episodes of hospital-treated major depression. A variety of definitions of depression were applied to the co-twins all of which resulted in (a) markedly higher rates of disorder than are found in the general population, (b) significantly higher monozygotic than dizygotic concordance. The results of applying a simple additive model in which depression is considered as a threshold trait suggested that both genetic factors and shared family environment make substantial and significant contributions to the familiality of depression.

Vocational rehabilitation for people with severe mental health problems is poorly developed in the UK. Although there is a clear evidence base indicating the effectiveness of approaches to helping people with severe mental health problems gain and retain employment there is generally a lack of awareness of this evidence. As a result there has been a lack of implementation within routine clinical practice of the most effective approaches to improving employment outcomes for such individuals.

After many years of hard work and training, the transition from trainee to consultant is potentially challenging. Having successfully negotiated the hurdles of preregistration training, the MRCPsych examination and the specialist registrar (SpR) interview, trainees have to pass one final signpost to mark the end of their formal training – securing their first substantive consultant psychiatrist post. Despite overall vacancy rates of about 12% for consultant psychiatrists in the UK (Royal College of Psychiatrists, 2002), competition can be intense for some posts.

In line with the Royal College of Psychiatrists' commitment to improve its professional examinations based on the best current evidence, Spring 2003 has seen the introduction of the objective structured clinical examination (OSCE). This has replaced the individual patient assessment (IPA) in the MRCPsych Part I clinical examination. An OSCE consists of a series of time-limited clinical tasks that candidates have to perform in a consecutive series of ‘stations' or booths. They have the advantage of being able to test clinical competence using a number of different scenarios via a standardised format (Katona et al, 2000). Their use has become widespread over recent years, particularly in undergraduate psychiatry exams (Brewin & Cantwell, 1997), as they have good reliability and validity (Hodges et al, 1998). This was confirmed by the College's initial pilot OSCE, which had a κ score of around 0.8 for the examination as a whole (Oyebode, 2002).

The MRCPsych Part II examination remains an important milestone (or barrier) for those wishing to pursue higher specialist training in psychiatry. There have been significant changes to the structure of this complex exam, with modification of the multiple choice question (MCQ) and essay papers and the introduction of the critical review paper. With pass rates varying from 39–49% over recent years, it clearly represents a significant hurdle for psychiatric trainees. This article aims to provide specific advice on how best to approach and tackle each of the components of the exam.

A sample of 49 ‘elderly graduate’ residents of a hospital designated for closure were surveyed in 1987 and followed up five years later. Twenty-two patients (45%) had died: the mortality rate was much lower than that predicted by the regional health authority and approximated to that of the general population. All but one of the survivors was living in supported accommodation at the time of follow-up. The majority were satisfied with the move and were receiving an appropriate level of care. However there was significant unmet need for structured activities and companionship. During the follow-up period the survivors had declined in functioning.