In response to concerns raised by GPs and mental health professionals, a postal questionnaire was used to ascertain level of knowledge about and attitudes towards the care programme approach (CPA) among general practitioners in one sector of Nottingham. Less than one-third of GPs who replied had heard of the CPA. GPs did not rate the benefit of CPA reviews highly and did not feel that they would be able to spare sufficient time to attend all the reviews to which they would be invited. Other issues of practical concern such as car parking at the local teaching hospital and provision of expenses were raised. Methods of acquiring valuable information from GPs must be reconsidered.

The Law Commission report on Mental Incapacity was published in 1995 and examines how decisions can be made on behalf of those who are unable to make decisions for themselves. It has far reaching implications for psychiatrists and recommends the introduction of new legislation. Research with those unable to consent, advance treatment directives, decisions about medical treatment and public law protection of vulnerable Incapable people are areas covered in the document. Although there are some concerns for psychiatrists, many of the proposals can be welcomed.

The children of women who take overdoses may suffer due to the same factors that predispose to the overdose, to witnessing the event and the immediate and long-term consequences of it. We examined what arrangements had been made for the children of 21 women admitted to hospital after an overdose, and enquired into the explanation that the mother planned to give the children. Children of mothers with psychiatric disorder were more likely to have witnessed the overdose. Mothers preferred that the children did not know about the overdose. The importance of this for the psychological development of the children is discussed.

The consensus statement by the Royal College of Psychiatrists recommended that patients on high dose antipsychotic medication receive regular electro-cardiographic monitoring to identify prolongation of the QT interval. A survey of trainee psychiatrists in three hospitals investigated the accuracy with which trainees could identify this abnormality and found only 20% could do so.

Three hundred and fifty-six patients admitted under sections of the Mental Health Act (1983) were studied. One hundred and twenty-six (35%) patients appealed against their detentions and 52 of these appeals were heard. Only 18 patients were discharged from their detentions by the Tribunal in the study period. Younger patients were more likely to appeal and no patient whose first language was not English appealed in the study period. The tribunals appear to be a fair system once the opportunity to appeal is taken up.

A cross-sectional study of 74 consecutive alcoholic patients admitted to a subregional alcohol treatment unit examines the socio-demographic and clinical differences between those who had/had not attempted suicide, and investigates their relationships to current suicidal ideation. The suicide attempters were significantly younger, separated and unemployed. They began regular drinking earlier, were more severely dependent and had a higher proportion of major depression, antisocial personality disorder and another drug abuse. The results suggest a high incidence of suicidal behaviour in alcoholics and high psychiatric comorbidity in alcoholics who attempt suicide.

Depot neuroleptic treatments can be compromised by side-effects unacceptable to users or, more seriously, by tardive dyskinesia (TD). Neuroleptic dosages can be lowered to increase acceptability and decrease the Incidence of TD, but with a greater likelihood of relapse. One argument proposes that many patients changing to lower dosages break down because withdrawal from a neuroleptic is stressful in itself. Research suggests that withdrawal regimes should be radically cautious. A computer tool is offered which can aid clinicians in calculating small reductions.

The characteristics of 452 patients referred over a two year period to a psychiatric service for the homeless population in inner London are described. The majority of patients were male and Caucasian, and tended to be referred through voluntary sector as opposed to statutory services. Fifty-nine per cent were sleeping rough at the time of first contact, 80% had a previous history of psychiatric treatment, but only 6% were currently in contact with psychiatric services. Serious psychiatric disorders predominated, with 52% suffering from schizophrenia or delusional disorders.

Feigned psychosis, although rare, presents considerable diagnostic problems in clinical psychiatric practice. Long-term follow up data are lacking. A retrospective case note study was undertaken of 10 patients described in a previous paper, published in 1970, on the simulation of psychosis. The computerised diagnostic instrument OPCRIT was applied to both index episode and lifetime occurrence of symptoms. All 10 patients were found to have had a major psychotic illness based on lifetime symptoms at 20 year follow-up by DSM–III–R criteria. Eight had met such criteria at the time of the initial episode. Diagnosis in patients thought to be feigning psychotic symptoms changes over time and major mental illness is likely to emerge which may be schizophrenic or affective. The term feigned psychosis should be abandoned and more attention given to why symptoms are accepted as genuine in some cases but not others.

A survey of a group of doctors and nurses specialising in the care of the elderly demonstrated a wide range of opinions on the usefulness of major tranquillisers for controlling behavioural disturbance in dementia. However, there was ‘broad agreement’ among medical and nursing respondents that these drugs were unlikely to be helpful in controlling non-violent resistiveness and sexual inappropriateness. The nurses indicated less ‘forth’ in neuroleptic therapy than their medical counterparts. The importance of auditing the use of major tranquillisers in dementia is emphasised.

Evidence-based medicine is an approach to clinical training and practice that is increasing in popularity. When introduced into the journal club format, it provides an opportunity to integrate real clinical problems with critical evaluation of the psychiatric research literature. The principles of evidence-based medicine and the practicalities of its introduction into the Journal club format are described.

We audited the use of high-dose antipsychotic drugs in patients admitted to a special (intensive) care unit over two periods. Five out of 57 patients in the first sample and three out of 62 in the second were treated with a single antipsychotic drug above the British National Formulary maximum dose. The proportion of patients treated with antipsychotic drugs such that the total dose in chlorpromazine equivalents was greater than 1000 mg, fed. The audit showed improvements in clinical practice, particularly with respect to the onset of, indication for and outcome of high-dose treatment and in monitoring the patients' physical status.

Murphy's law states that if something can go wrong it will go wrong. Our recent experience in organising the MRCPsych exam at two centres confirms the general validity of this aphorism. We wish to share our experiences with other senior registrars who may find themselves in a similar predicament.

This article briefly describes the experience of two final year senior registrars visiting services in other regions. The potential training benefits of such external placements for higher trainees are outlined and practical suggestions are made on how to make them more widely available.

By describing a conjoint job-share in a single registrar post on an acute adult psychiatric ward in Wellington, New Zealand, this paper contributes to the growing literature on the subject of part-time training. We shared, on the one hand a registrar post and, on the other hand, our domestic life and the raising of our first child. We supplement our subjective impressions with information gathered from the multidisciplinary team, using a short

“You try to be kind, but you know you feel it when a patient despises you because of your colour. They give you a cold look and you cannot reach them”.

The mayor of Sao Paulo, Paulo Maluf, has a bullish approach to arguing and is not renowned for his subtlety. Despite this he has been a key campaigner and instigator of various public health policies that form part of an international “healthy city” initiative. The most successful of these has been the introduction of a law making the use of car seat belts compulsory, which has led to a massive reduction in the number of fatal road traffic accidents. An attempt to prohibit cigarette smoking in restaurants has been less successful owing to a number of legal challenges that have left the legislation in a consitutional and legal limbo – but the fight goes on.

The International movement of traders, political envoys and soldiers is not new. But the late 20th century has seen an unprecedented growth in the activities of at least the first two groups. Increase in international mobility has been accompanied by growing interest in the psychological problems faced by these temporary migrants. It has prompted the development of specialised services for preparing expatriates before departure, and supporting them during their sojourn. Brussels is an example of an International centre with a huge expatriate population, and a demand for a dedicated telephone crisis service. This is the oldest, and one of the largest, services of this kind in Europe.