Mental health morbidity is perceived as being predominantly urban based. Little is known about the health of the UK's rural residents. This paper summarises existing knowledge of rural health and social indicators. There is a relative dearth of information in this area making the application of urban-based (and biased) factors perhaps unreliable. Some rural areas have levels of deprivation similar to urban areas, even using urban-biased factors, though they encounter specific problems of service provision and accessibility. Currently, there seems to be no valid method of measuring rural deprivation and comparing it with urban deprivation. We highlight this inequality by describing discrepancies in day care provision between urban and rural areas.

A postal questionnaire concerning the management of cognitive impairment of vascular origin was completed by 88 psychogeriatricians and 100 geriatricians. Aspirin was considered an important part of management, and clinically indicated with: a history, or clinical signs of stroke; computerised tomography (CT) scan changes suggestive of cerebrovascular disease; and atrial fibrillation. Advanced dementia was seen as a contraindication for treatment. Eighty per cent of responders indicated they would institute antihypertensive therapy in an elderly patient with a history of raised blood pressure and cognitive impairment. The median lower limit of systolic blood pressure requiring treatment was 160 mmHg, with a treatment target blood pressure of 150 mmHg.

The views of general practitioners (GPs) on the priorities for a new old age psychiatry service were obtained. Most GPs identified dementia patients with behavioural or psychiatric disturbance as being the greatest priority for an old age psychiatry service. There was less consensus on the priorities for delivery of the service, but hospital-based services such as in-patient and day hospital facilities remain high on the GPs' priority list. There was a widely-based desire for results of assessments to be communicated by telephone, followed later by letter. These findings have been taken into account in the development of our new service.

A survey was undertaken to establish the current state of liaison psychiatry in England, Scotland and Wales. Eighty-six consultants were identified who carry out specific work in liaison psychiatry, 43 of these consultants hold either full-time or half-time posts in liaison. Sixteen new posts in liaison (full-time equivalent (FTE) or half-time equivalent (HTE)) have been created in the past two years. Half of these were entirely new posts and half have been created by consultants already in a general psychiatry post renegotiating their contracts. Some specialist registrar schemes have no training slots in liaison psychiatry and others have training slots in liaison psychiatry which are supervised by a trainer who is not in a FTE/HTE liaison post. A national database is required to track expansion in liaison psychiatry and training at specialist registrar level needs to be developed.

Annual admission rates from the North-East Thames Region to maximum- and medium-secure forensic psychiatry services demonstrated a highly significant correlation with social deprivation measured at district health authority level using the Jarman UPA 8. There were specific associations with the number of unemployed persons, overcrowded households, and persons from ethnic minorities in the districts studied. There was a 10-fold difference in treated prevalence rates across the region, indicating that certain purchasing authorities may be seriously underfunded to meet the needs of their catchment area populations for secure forensic psychiatry services. Further research is required into the nature of the association between admissions to these services and social deprivation. It is readily apparent that a new formula is required for the allocation of resources in the face of such wide disparities in demand from different geographical locations.

The extent to which electrical dose exceeds the seizure threshold is an important determinant of the efficacy of electroconvulsive therapy (ECT) but seizure thresholds have not before been evaluated using an ECT machine made in the UK. In this study seizure threshold was empirically titrated at the outset of bilateral ECT given to 100 consecutive depressed patients treated with an Ectron Series 5A ECT machine. No patient received anti-epileptic drugs. Men and women under 30 years of age (n=14) had low thresholds and men of 60 years or more (n=3) had high thresholds. Seizure thresholds varied at least threefold among other groups, suggesting that empirical titration may be desirable for most patients treated by bilateral ECT.

Twenty-four patients in the Gloucester rehabilitation service were considered suitable for clozapine treatment between January 1993 and May 1996. Five patients consistently refused to start clozapine and four patients (21%) discontinued clozapine, usually due to side-effects. Eight patients showed ‘some positive response’ and seven ‘good positive response’, of the 15 still taking clozapine. High rates of side-effects, but low readmission rates were found in this group. Putative reasons for the low discontinuation rates and apparent success of clozapine treatment in Gloucester include the wide experience engendered in the single consultant-led rehabilitation team, and the better coordinated, uniform approach to managing problems through the Clozapine Clinic.

Mental health professionals are becoming increasingly involved with the criminal justice system through their work in psychiatric assessment and diversion schemes. Preparation of reports for the courts requires knowledge of the legal system. Those preparing such reports need specific training for this work.

This study, assessed 63 older, long-stay, learning disabled patients, the Health of the Nation Outcome Scales (HoNOS) highlighted the expected problems in areas of cognition, physical illnesses or disabilities, relationships and activities of daily living. No significant changes were observed in the problems assessed using the HoNOS over a six-month period in this group of patients with relatively stable health problems and needs. HoNOS proved to be useful in identifying some expected problems. However, further studies are needed to assess its sensitivity to changes secondary to improvement or worsening of problems along with wider use to see if its brevity allows it to give sufficient detail on the problems of persons with learning disabilities.

This study was undertaken to assess whether psychiatric patients respond more adversely to reading their own records than non-psychiatric patients. Seventy-three psychiatric out-patients and 84 out-patients with diabetes were posted their main clinical summary with a questionnaire about it. For seven of the eight questions, more than 70% of both patient groups gave favourable ratings. However, the psychiatric patients gave significantly less favourable responses than the patients with diabetes on five of the eight questions. Fourteen of 73 (19%) psychiatric patients were upset by reading the clinical summary about themselves compared with four of 84 (5%) patients with diabetes.

The principle is less strange today than when it was first proposed, but making hospitals safe for patients is no easier. Stepping aside from one danger, one may fall into the path of another. Legionella risks can be avoided by higher water temperatures but this in turn introduces a risk of scalding. Security measures can protect the individual and work space but may compromise fire safety. This paper describes a similar problem of conflicting safety measures and its unfortunate consequences.

This family blockbuster film is about aliens given asylum on earth on condition they follow certain rules. Basically these are to live in a stated place, to allow access to the Men in Black and to remain in human disguise while in public places so as to not frighten the natives. The heroes are human secret agents who monitor the well-being of the aliens and ensure that they abide by their conditions of residence. Striking parallels with recent mental health developments are evident, particularly to at-risk registers and supervised discharge orders. This paper discusses these similarities and their possible consequences referring to events in the film to illustrate relevant points.

Some names appear to stick to syndromes or diseases like a proverbial glue, regardless of their total inappropriateness. Gross self-neglect in old age characterised by domestic squalor, social withdrawal, apathy, tendency to hoard rubbish (syllogomania) and a lack of shame was originally reported by Macmillan & Shaw in 1966 and subsequently ‘christened’ by Clark et al as Diogenes∗ syndrome in 1975. Post (1982) preferred the term ‘senile recluse’ and argued that this is not a syndrome but merely an end stage of personality disorder. It was usually extremely difficult to help these patients, as one's care and goodwill often met with hostility and blunt refusal to cooperate (Cybulska & Rucinski, 1986). More recent studies, however, have shown a strong association of this condition with frontal lobe dysfunction (Orrell & Sahakian, 1991), thus giving a psychiatrist of old age a somewhat firmer basis for action.

Edgar Degas (1834–1917) is perhaps best remembered for his pictures of women bathing and of ballet dancers. The awkward posing, the physical unattractiveness and the voyeuristic viewpoints that are characteristics of many of his later works have given him a reputation for misogyny. A lesser known aspect of Degas' work concerns portraiture. In the earlier part of his career he painted many portraits of his family and friends which are remarkable for their psychological insights as well as their technical and compositional mastery. One of the finest is the portrait of the Bellelli family which he started in Florence in 1858 and appears to have worked on intermittently until 1867. Its large size (200 x 250 cm), the length of time in execution and the number of preparatory studies all point to its significance in the artist's eyes. Despite this, scholars doubt that it was ever exhibited during Degas∗ lifetime and was discovered with considerable surprise in his studio following his death (Boggs, 1994).