The populations in the large mental handicap hospitals are known to be diverse, ranging from elderly non-psychiatric residential groups to acutely psychotic and behaviourally disturbed patients. At present demographic variables, medical and psychiatric characteristics of populations in these hospitals are changing in parallel with implementation of community care and resettlement programmes. In resettlement programmes, discharge priorities have been given to the easy to manage and less dependent residents while new challenging behavioural units and admission assessment wards are being opened to care for the multi-handicapped population.

We have evaluated the effects of providing a ‘roving’ psychiatric clinic to local authority residential homes for the elderly. The clinic was well received by the staff in the homes, reduced the need for urgent domiciliary consultations and hospital admission and appeared to be highly cost-effective.

General practitioners in a south London health authority were sent a questionnaire about their experience and views concerning the treatment of childhood chronic fatigue syndrome. Most thought childhood chronic fatigue syndrome had a significant psychological component, but opinion was divided over referral to a psychiatrist. The involvement of self-help organisations was supported but the place of rest and exercise unclear. The optimum primary care management of childhood chronic fatigue syndrome needs to be established.

Using a case note study, this paper presents a longitudinal survey of the effect of psychiatric inpatient care on benzodiazepine prescribing. Standards were proposed to assess the quality of this prescribing. Based on these standards, the study shows inappropriate use of benzodiazepines. Following admission, there was an increase in the number of patients prescribed benzodiazepines and in the number of benzodiazepines prescribed. Of the benzodiazepines withdrawn, most were contrary to the proposed standard. The quality of drug history showed little emphasis being placed on rationalising benzodiazepine prescribing. The issue of how benzodiazepines should be handled during psychiatric admission is discussed.

The Department of Health and National Institute for Mental Health in England have undertaken a programme of research and policy development since spring 2004 in partnership with the Home Office which has important implications for the practice of psychiatry. This article looks at the Victims of Violence and Abuse Prevention Programme (VVAPP) guide ‘Tackling the Health and Mental Health Effects of Domestic and Sexual Violence and Abuse’ launched in 2006, supported by Department of Health and Home Office ministers and national clinical directors.

Over the past few years, numerous articles have highlighted the strain on (and drain of staff from) our specialty. Many general adult psychiatrists are developing bleak views of themselves, the world and the future. Encouragingly, consultants such as Hampson (2003) are structuring their roles with some success. However, we are going through a major overhaul of the model of delivery of care and need to adapt our roles accordingly. Although tuning a Triumph Spitfire might make it run more smoothly for a while, it is still an inferior beast compared with a modern car and might be better on the scrap heap. A more radical approach is needed, which we outline in this article. One of the authors (G.I.) has experience of working as a consultant psychiatrist in Australia, where the state of Victoria changed the model of delivery of general adult psychiatric services to adopt a superior American model, leading to improved patient and carer satisfaction (Joy et al, 2001). The same model has been adopted by the UK government (Department of Health, 2001) through the creation of crisis assessment and treatment services (CATS), assertive outreach teams, and specialist community and in-patient services. Consultant psychiatrists are challenged to adapt their practice accordingly. The Royal College of Psychiatrists has recently set up a Working Group to address this issue (Royal College of Psychiatrists, 2004).

Attention-deficit hyperactivity disorder (ADHD) and its pharmacological treatment remain the objects of intense controversy. The conflict reaches far beyond the area of scientific debate. An article on ‘behavioural syndromes', published in The Times on 28 July 2003, was headlined: ‘Hyperactive? Just go to a park and climb a tree’. An internet search will produce equal numbers of sites warning either that the prescription of stimulant medication is a denial of children's human rights, or that not prescribing stimulant to an ADHD child denies their right to treatment.

Agomelatine is a new antidepressant, licensed for the treatment of unipolar major depression, with a mode of action that combines activation of melatonin receptors with blockade of 5-HT2C receptors. Agomelatine is notable for its short duration of action in the body and modest side-effect burden; however, a number of theoretical and practical challenges have limited its adoption into mainstream treatment in the UK. Current meta-analyses show marginal clinical benefits of agomelatine relative to placebo and an association with occasional increases in liver transaminases. Theoretically it is not clear whether agomelatine does block brain 5-HT2C receptors in humans at therapeutic doses and the optimum daily timing of administration in depression has not been clearly established. However, agomelatine's novel mode of action justifies further study, perhaps with the eventual aim of matching its use in depression to patients with specific disturbances in circadian rhythm.

Rates of developmental delay, autism and mental illness in deaf children are higher than in hearing children. Early language acquisition (signed or spoken) is a protective factor against mental disorder. Deaf children and their families are often given conflicting messages and advice about their upbringing and many are unable to access generic child and adolescent mental health services (CAMHS). We describe the National Deaf CAMHS, a service that has been set up to answer the needs of this group of patients. It uses specialist intervention which incorporates some aspects of Deaf awareness to empower deaf children and reduce the burden of mental health problems that are likely to accompany them into and throughout their adulthood.

EDIFY (Eating Disorders: Delineating Illness and Recovery Trajectories to Inform Personalised Prevention and Early Intervention in Young People) is an ambitious research project aiming to revolutionise how eating disorders are perceived, prevented and treated. Six integrated workstreams will address key questions, including: What are young people's experiences of eating disorders and recovery? What are the unique and shared risk factors in different groups? What helps or hinders recovery? How do the brain and behaviour change from early- to later-stage illness? How can we intervene earlier, quicker and in a more personalised way? This 4-year project, involving over 1000 participants, integrates arts, design and humanities with advanced neurobiological, psychosocial and bioinformatics approaches. Young people with lived experience of eating disorders are at the heart of EDIFY, serving as advisors and co-producers throughout. Ultimately, this work will expand public and professional perceptions of eating disorders, uplift under-represented voices and stimulate much-needed advances in policy and practice.

This study examined the impact of caring on women who were primary care-givers to those with schizophrenia. From the 46 women and 21 men carers assessed for the study, women were considered primary care-givers more often than men (83% v. 57%). Higher levels of burden among women primary carers were associated with living with patients, and more hours in contact with them. Worse perception of patients' social functioning was associated with higher levels of burden. The findings of the study showed that women primary carers have particular needs, and services should consider how to provide support for them in their multiple roles, and over longer periods of time.

A working group was brought together in a 2-day workshop by the Sub-Dean to take forward training in transcultural psychiatry. The group comprised senior members of the College; psychiatrists with particular expertise in transcultural issues and/or education; and included trainers from undergraduate to continuing professional development (CPD) level.