The eating disorders of childhood and adolescence lie in the murky waters between those of adulthood anorexia nervosa and bulimia nervosa, and the feeding disorders of childhood. Early-onset eating disorders include anorexia nervosa, on which this article will focus. The younger the patient, however, the more likely he or she is to present an ‘atypical’ picture. Anorexia nervosa and bulimia nervosa have been previously addressed in this journal, by Palmer (1996) and Fairburn (1997). With older adolescents, ideas relevant to adult patients will be appropriate at times. Nevertheless, developmental issues should be borne in mind.

Improvements over recent decades in acute care of the brain-injured now ensure that all but the most severely injured survive. The legacy of that survival is an increasing number of people with enduring organic mental disorders. Here, I will focus upon the psychiatric sequelae of five types of severe single-insult brain injury: head trauma, subarachnoid haemorrhage, and hypoxic, hypoglycaemic and postencephalitic injury. Thrombotic stroke is a common and important cause of brain injury but the psychiatric consequences have been more extensively studied and are fairly well-known (Robinson & Price, 1982; Starkstein et al, 1987). Damage due to alcohol and associated malnutrition is also well-documented (Jacobson & Lishman, 1987, 1990). Neither will be specifically addressed here, though some of the consequences of brain injury are similar, regardless of cause.

Carlyle Jacobsen and John Fulton, at Yale in the early and mid-1930s, investigated primate frontal lobe function. Following bilateral frontal lobecotomy, monkeys and chimpanzees developed a delayed-response deficit, being unable to perform tasks when there was a significant delay between the stimulus and the required response. There were accompanying behavioural changes, with the animals becoming more placid and lethargic and losing their characteristic inquisitive initiative. They became distractible, with difficulty in maintaining an attention set. They had great difficulty in adapting to changes in the directions of an already learned task, tending to perseverate.

“Contrary to popular belief, partial recovery from Korsakoff's Psychosis is the rule and 21% recover more or less completely. However the extent to which the patient will recover cannot be predicted with confidence during the acute stages of the illness. Failure to appreciate these facts about the natural history of the mental illness may result in the premature confinement of the patient to a mental hospital” (Victor et al, 1971).

Complaints of poor memory are common in the healthy elderly and to many it may seem unsurprising that cognitive function declines with ‘normal’ ageing. Virtually every biological system alters with age and, just as a 70-year-old cannot run as fast or hear as well as when he or she was 20, it is perhaps inevitable that cognitive function also becomes impaired. However, far from being straightforward, the nature, classification and clinical significance of age-related cognitive changes that fall short of dementia remain a most controversial and difficult area (see O'Brien & Beats, 1994; Dal Forno & Kawas, 1995). The recent emergence of new drugs for the treatment of Alzheimer's disease (donepezil and rivastigmine) and related disorders has emphasised the need to study groups with milder degrees of cognitive impairment. It is necessary to determine whether such conditions are benign and non-progressive, or harbingers of progressive dementia and so appropriate conditions to target for early therapeutic intervention. The presence of age-related cognitive changes raises other important issues including why such changes occur, how they should be classified and whether, even if ‘benign’, they can and should be treated.

Psychosocial aspects of treatment have become increasingly important with the changes in psychiatric practice away from the hospital to the community. Effective psychosocial interventions and high staff morale are likely to be the key to the success of a community-based mental health service. There is a growing expectation that all psychiatrists should have a basic knowledge of therapeutic approaches in order to take a leading role in the multi-disciplinary team. They should be able to assess patients for a range of psychological and psychotherapeutic treatments. This role is vital as the matching of the patient's needs with the appropriate treatment is the key to a successful outcome.

Dreams have been described as “an endangered species” in general psychiatry nowadays (Holmes, 1991). Liam Hudson (1985) suggests the danger derives from a society which has embraced a naïvely reductionist, oversimplified understanding of neurophysiology. But Hudson also sees a threat to dreams from the increasing variety of visual imagery available for personal creative adaptation through television, computer programs and video recording. Researching this article, I was unable to find a single reference to dreams in the British Journal of Psychiatry over the past 12 years. Theories about dreams are taught to trainee psychiatrists as historical background. In recent years there has been a revival of psychiatric interest in only one kind of dream –‘flashbacks' of traumatic experiences as a feature of post-traumatic stress disorder.

The publication of Tomorrow's Doctors(General Medical Council, 1993) opened our minds to the need for a more thoughtful and evaluated approach to education in medicine. The expansion of medical knowledge has shown no sign of slowing, which makes it imperative that we find ways to prioritise and organise what we teach so that students are given a clear structure. Learning objectives are one of the building blocks that give order to what we do with and for our students.

Clinical skills in psychiatry are not best acquired in unsupervised practice or in learning by apprenticeship. In the past, it was reported that during the course of their clinical training, students' interviewing skills actually deteriorated rather than improved (Helfer, 1970; Maguire & Rutter, 1976), although recent research suggests that improved training is now having an impact (Davis & Nicholaou, 1992). The methods described below may be employed at both undergraduate and postgraduate level. Traditionally, psychiatrists have been actively involved, along with general practitioners, in the provision of communication skills training to undergraduates. In the future, this training will become a continuous process carried out alongside and within other teaching in all specialities (Gushing, 1996). One of the biggest challenges facing medical schools is how to engage and train clinical teachers from a range of specialities in facilitating students in the acquisition of clinical interpersonal skills.

All forms of teaching, including giving a lecture or a seminar, are intended to fulfil one or more particular aims. In planning a presentation, it is helpful to begin by defining the intended aims of the presentation and associated objectives. The aims and objectives will help to determine what methods to use, and what teaching aids might be appropriate. For example, if the main aim of a presentation is to provoke thought and discussion among the audience on a controversial topic, a didactic talk in a large auditorium to a widely dispersed audience is less likely to fulfil this aim than a facilitated interactive discussion in a smaller room with seating not fixed in rows.