This paper examines the question of whether chronic fatigue syndrome (CFS), often known as myalgic encephalomyelitis (ME), should be classified as a physical or mental illness.

Antipsychotic drugs are among the most widely prescribed psychotropic medications for elderly people, particularly for the 5–8% of patients who are in institutions. The antipsychotics are indicated for treating psychotic disorders, including schizophrenia, delusional disorder, psychotic symptoms in mood disorders and for a number of organic psychoses.

Multi-sensory therapy is an activity which usually takes place in a dedicated room where patients experience a range of unpatterned visual, auditory, olfactory and tactile stimuli (Baker et al, 1997). These rooms are designed to create a feeling of comfort and safety, where the individual can relax, explore and enjoy the surroundings (Fig 1.).

This article aims to provide a practical overview concentrating on civil legal aspects of psychiatric care for the elderly. We limit ourselves to English law (which also has jurisdiction in Wales; Scottish and Northern Irish law may be similar, but not identical). Civil law can, in turn, be divided into statute law (legislation provided by Parliament) and common law (the UK, unlike some European countries, has a strong tradition of law based on previous rulings by judges).

A classification system can benefit disturbed children enormously by bringing to bear a wealth of knowledge and experience. This can make all the difference between an inadequate consultation and a precise formulation of the nature and extent of a child's difficulties, their cause, the likely outcome and a realistic treatment plan. However, inappropriate application of a diagnostic label that has little validity could do more harm than good, and classification systems can be misused. This paper discusses, with examples, issues particular to childhood and adolescence that diagnostic systems need to address if they are to be useful. It considers different solutions applied by the two most widely used schemes, the International Classification of Diseases (ICD–10; World Heath Organization, 1992) and the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV; American Psychiatric Association, 1994). Finally, the types of criteria used to validate categories are discussed.

Home visits by old age psychiatrists remain popular with elderly patients, their carers and general practitioners (GPs). Home assessments by various disciplines working with older people have been endorsed as a sign of good practice by the Audit Commission (2000) in their recent national report on mental health services for older people:

Children who have a learning disability are at increased risk of sexual and physical abuse and neglect. They and their families are more likely to be socially isolated and to suffer material and emotional poverty. The range of emotional reactions in carers can vary at different times from extreme overprotection, through relative equanimity, to sometimes outright hatred and rejection of the child. Society largely reflects this, only rarely viewing the individual with learning disability in a positive way, choosing often to pity, patronise, ignore, ridicule or openly despise. These attitudes are internalised by children with the disability, who invariably suffer from low self-esteem. All of these factors combine to facilitate abuse.

Comprehensive health care services respond effectively to the needs of their patients not just in terms of treatment of health problems but also by addressing overall well-being by understanding, informing, involving, counselling and respecting the individual. By contrast, the history of health care for people with learning disabilities has been characterised by a lack of communication and poor understanding of their ordinary and special needs. There have been many barriers to access to health services that most members of the population take for granted. In addition, people with learning disabilities have many special health care needs that also have to be addressed. Therefore, person-centred services must be aware of the wide range of needs to which they must be able to respond while treating each person as an individual (see Box 1).

Violence towards psychiatrists has been recognised as an occupational hazard for many years. With the development of community care it is increasingly likely to be encountered outside the hospital. To maximise personal safety in the community, psychiatrists need to be working in trusts in which an infrastructure to establish and maintain safety standards is in place.

Murray & Jacoby (2002, this issue) emphasise the functional nature of capacity and draw attention to the dangers of adopting any other approach. The status approach (where determining whether someone is capable is dependent on diagnosis) makes assumptions about individual capacities and abilities that may be, and often will be, untrue. The outcome approach fails to realise that no one is expected always to make decisions with which others would agree. It is the process of decision-making that matters, and this must be determined in the case of an individual and in relation to a particular decision at a particular time.

It is not uncommon for people with mental illness to be convicted of a criminal offence. The relationship between the two is not necessarily simple. It may be diffuse and subtle, perhaps relating to the disinhibiting effect of severe mental illness or associated factors such as poor social integration, unemployment, lack of close and intimate relationships or substance misuse.

Getting to grips with critical appraisal is not easy. To some extent, it is a metaphorical bandwagon, overloaded with dogma, misinformation and mathematics. Its introduction into the MRCPsych curriculum (Royal College of Psychiatrists, 2001) has left many trainers trying to catch up with their trainees' skills. This paper attempts to demystify some of the concepts, provide a balanced overview of the advantages and drawbacks of critical appraisal, and discuss ways of developing skills in critical appraisal.

Almost all current research into developing new pharmacological treatment for depression and schizophrenia is focused directly on modulating neurotransmitter receptors in the brain. This approach was stimulated by the chance discovery of the prototype psychotropic drugs such as chlorpromazine and imipramine and the subsequent development of hypotheses based on the presumed mode of action of these drugs. Even clozapine was first introduced as yet another dopamine receptor blocker, and it was only after it was recognised that clozapine shows improved efficacy that hypotheses were developed as to its possible mode of action. Subsequent research based on the receptor approach has led to improved side-effect profiles for modern psychotropic agents, but has not resulted in any improvement of efficacy over and above that of the drugs discovered by good fortune rather than by hypotheses.

In the first three papers of this series (Williams & Garland, 2002a, b; Wright et al, 2002), we looked at the different areas of human experience that alter during times of mental illness. The Five Areas Assessment model (Williams, 2001; see Williams & Garland, 2002a, Fig. 1) provides a clear summary of the range of problems and difficulties faced by individuals in each of the following domains:

1. 1 life situation, relationships, practical problems

2. 2 altered thinking

3. 3 altered emotions (moods or feelings)

4. 4 altered physical feelings/symptoms

5. 5 altered behaviour or activity levels.