The role of pharmacotherapy in the management of depressive disorders is well-established and frequently reviewed. This paper focuses on the prospects for reducing the incidence, prevalence and morbidity of depression through psychosocial interventions. A central requirement in prevention is a knowledge of the epidemiology of the disorder being investigated. This data can be used to identify high-risk groups. By comparing the number of known cases with population levels of morbidity, it allows comment on help-seeking behaviour and accessibility of services. Also, differences in incidence and prevalence rates give some indication of the chronicity of the disorder.

The 1988 US Surgeon General's Report entitled Nicotine Addiction reviewed the mass of evidence on the role of nicotine in tobacco consumption and came to three main conclusions, shown in Box 1.

Since the introduction of lithium therapy 30 years ago it has become a major weapon in psychiatrists' armamentarium. It is the drug of first choice for the prevention of recurrent mood disorders, and it is estimated that about one person in every thousand people in Britain receives lithium at any one time. It therefore behoves doctors to be familiar with its use. This article is not a comprehensive account of the pharmacology of lithium (for this the reader is referred to Johnson (1987) and Peet & Pratt (1993)) but concentrates on its clinical use in practice and some less well known, but important, phenomena.

Advances in the understanding of the genetic causes of some neuropsychiatric disorders are having an impact on clinical practice as direct mutation analysis becomes possible. Mutation analysis is now available in UK Health Service diagnostic laboratories for Huntington's disease (HD) and the fragile X syndrome (FRAXA). Psychiatrists need to be familiar with issues surrounding presymptomatic and diagnostic testing in HD and diagnostic and carrier testing in FRAXA. They may be asked to assist clinical geneticists in the assessment of candidates for HD presymptomatic testing and a suggested mode of assessment is described here. The procedure for HD will provide the model for use with other familial neuropsychiatric disorders of late onset, notably familial Alzheimer's disease (FAD). Testing for FAD is already possible in conjunction with research laboratories in the few families where a mutation has been discovered and we shall have more tests for FAD within a few years.

Happy New Year, and welcome to what some are predicting will be the year of continuing professional development/ continuing medical education!

Liaison child and adolescent psychiatry has been described as the “partnership of child psychiatrists, paediatricians and other specialities concerned with children to provide integrated medical and psychological care for children” (Black et al, 1990). Although liaison work conjures up visions of the psychiatrist on the paediatric ward, it may also involve collaboration with community paediatric and primary care services. Indeed, the number of different professionals that may be involved with even quite mildly ill children is large (see Box 1). Much of the work is indirect (e.g. consultation with other professionals), but this and direct therapeutic work with children and families may continue long after discharge from the paediatric wards and clinics.

One of the most valuable commodities in the NHS is the individual consultant's time. This is what patients, their relatives, and other staff want most, and they complain that it is not sufficiently available. We increasingly examine the use of our resources and the quality of our service but do not pay sufficient attention to this variable. This article aims to highlight the importance of the clinician's time and suggests that it should be subjected to periodic audit, along with other aspects of the service, and that the duration of face-to-face contact with patients should be introduced as one of a series of quality measures.

Jealousy has traditionally been treated by offering medication, support, or various forms of individual psychotherapy or counselling. However, jealousy is usually a condition which has a profound effect on the sexual partner of the jealous person, and they may actually suffer more from the condition than the person him/herself. While accepting that medication and other individual approaches have their place in the management of jealousy, there seem to be several advantages in seeing the problem from the standpoint of the couple relationship. Firstly, couple therapy reduces the almost inevitable labelling of the jealous person as a psychiatric case. Secondly, one might argue a priori that any changes which take place as a result of two people changing their behaviour are likely to be more stable and long-lasting than if just one person changes. There is another consideration, namely that, since the relationship is bound to be affected by the jealousy, it will need attention regardless of the means used to treat the jealousy itself.

Case registers have very little to do with computers or any other form of mechanical calculating machine. To write an article on case registers which concentrated on information technology would be as logical as an article on open heart surgery which confined itself to the finer points of scalpel technology. The creation of a case register is as simple or as complicated as the clinician wishes it to be; a case register at its purest is simply a list of contacts with patients, organised to a predetermined format, which allows the clinician to gain information from the list for education, research, planning or administration. The work needed to establish a case register, however, should not be underestimated, and the time spent in thinking through reasons for development of a register is a worthwhile investment. An understanding of the history of the development of psychiatric case registers may help those wishing to develop new registers to avoid treading well worn cul-de-sacs, while reviewing some of the work which has resulted from case registers may demonstrate the enormous potential of a well-designed register in facilitating the extension of knowledge about treatment and provision of services.

Anxiety pervades every aspect of human activity and experience. It is a normal state and a spur to action, but readily exceeds normal limits in intensity, duration and appropriateness to the stimulus or situation. Anxiety is manifest by the mood of fearfulness, behaviour marked by restlessness and avoidance of situations, increased arousal with insomnia, excessive preoccupation with thoughts on the theme of insecurity, and a wide range of somatic symptoms which are based on muscular tension, hyperventilation leading to paraesthesiae and faintness, and symptoms based on overactivity of the autonomic nervous system. Excessive anxiety and situational avoidance leads to diminution of performance and limitation of endeavour. In the context of physical illness, anxiety increases the distress of symptoms, may confuse diagnostic procedure, prolong recovery time from acute illness, cause failure to comply with effective treatment and promote destructive habits such as reliance on alcohol or excessive use of sedative drugs.

The first electroconvulsive treatment was administered by Cerletti and Bini in 1938. The event was essentially an experiment, carried out like a military operation (Endler, 1988). The patient was stimulated three times, each time increasing the intensity of the stimulus before a generalised seizure was induced. He had been suffering from an acute psychosis with a poor prognosis, but responded to a course of 11 treatments and was discharged free of symptoms two months later. The first paper on electroconvulsive therapy (ECT) in English was published in the Lancet (Kalinowski) in 1939. At that time, somatic treatment alternatives for the severely ill in large mental institutions included lobotomy and insulin coma therapy. In comparison, unmodified ECT (albeit associated with a significant risk of serious physical morbidity) was predictable, efficient, quick and effective. It is understandable why the treatment became widely and fairly indiscriminately adopted before systematic objective evidence of its efficacy was collected.

It is hard to disagree with the principles of the care programme approach (SPCR, 1993; Kingdon, 1994) but it has been much harder to agree how to put them into practice. What should be ‘just good practice’ becomes more complex the more it is discussed by clinical teams.

“Chronic fatigue syndrome” (Sharpe et al, 1991) is an operational definition for conditions of disabling physical fatigue, of over six months duration, unexplained by primary physical or psychiatric causes. It encompasses nomenclature such as “myalgic encephalomyelitis” (Acheson, 1959), “post-viral fatigue syndrome” (Behan et al, 1985) and “chronic mononucleosis syndrome” (Straus, 1988).

The notion of brief dynamic psychotherapy (BDP) may seem at first sight to be a contradiction in terms. ‘Dynamic’ is a Freudian psychoanalytic term implying conflictual psychological forces — an opposition between the conscious and unconscious mind, and the use of defence mechanisms to arrive at a compromise between them. The rigidity of the obsessional person whose self-expression is traded for security, the self-reproaches of the depressive reflecting inhibited aggression, the clinging of the phobic individual who lacks an inner sense of a secure base — these would be examples of the relationship between dynamic conflict and psychiatric symptoms. But the image of psychoanalysis conjures up a picture of prolonged and intensive couch-based therapy. How can this be brief?