This first of a series of articles intended to guide clinicians through the evidence-based process assesses the published evidence for drug therapy in Alzheimer's disease. A Medline search identified a randomised, controlled trial of donepezil. Although this trial appeared to have a reasonably sound methodology, we had some doubts about the treatment effect and applicability of the results.

This study addresses the perception among senior trainees that the lot of a consultant general psychiatrist is currently not a happy one and that transition from training to consultant grade can be difficult. Reasons for this are explored and alternatives suggested that might make the move from senior/ specialist registrar to consultant general psychiatrist a more rewarding and attractive proposition.

A postal survey was carried out on a random sample of Fellows and Members of the Royal College of Psychiatrists in the United Kingdom or Eire in order to investigate current Continuing Professional Development (CPD) practice and the impact of resources and funding for CPD. One hundred and thirteen of 264 anonymised questionnaires were returned (43%). Most respondents considered CPD should be mandatory for consultants, for educational supervisors, for eligibility for the Certificate of Completion of Specialist Training and for election to the Fellowship of the College.

Absconding constitutes a significant clinical problem, leading to high levels of anxiety among staff. Ninety-five psychiatric in-patients who absconded from an Irish hospital over a period of 12 months were reviewed retrospectively. Absconders were significantly more likely to be single and compulsorily detained with a diagnosis of schizophrenia or personality disorder when compared to the remaining hospital population for that year. Common destinations included the public house and home, with most returning of their own volition within 24 hours. The rates of self-harm and violence against others are recorded.

Respite needs for carers of persons with severe mental illness were assessed using a semi-structured inverview. Very few carers were currently using respite facilities. The need for respite was widespread, although largely unmet. Carers shared clear and definite ideas concerning the layout of a good respite service.

The Bethlem Royal and Maudsley Hospitals Item Sheet system for registering clinical data generated by psychiatric assessments is long established, with a proven track record as an instrument of scientific research. However, its use has not spread beyond the originating institution, despite being available in the public domain for many years. To address this problem we have designed a modified version of the Item Sheet. The new system has been simplified and improved to facilitate the use of this research aid in child guidance clinics and similar settings.

Services for adolescents who overdose remain variable in the UK despite College guidelines. The problem is significant in terms of the demand placed on services, the level of distress it represents and the high eventual mortality rate. This study was undertaken to gain an understanding of the local picture with a view to improving service provision. The study revealed a high level of psychiatric morbidity, considerable drug and alcohol misuse and paracetamol as the most commonly taken substance. The findings supported Hawton's classification into three distinct groups, confirming it as a simple but useful system. This may provide a means of screening adolescents who overdose to improve service delivery to those most in need within the resources available. The possible role of the primary child and adolescent mental health worker is discussed.

This report describes one of the largest published surveys of users' views of services, with 287 users returning a 34-item questionnaire and 80 people interviewed about their views and satisfaction with services provided by two psychiatric day hospitals. The combination of questionnaire and interview methodologies provided data such as an overall satisfaction score (which was relatively high) and satisfaction scores with specific aspects of the service, as well as highlighting specific problems and providing recommendations on how to make improvements.

Despite widespread acceptance that the sexual history is an important part of psychiatric assessment, concern continues to be raised that such questions are often neglected. It has been suggested that one reason for this is the belief of staff that patients do not want to discuss sexual matters. The response of 65 out-patients to a questionnaire concerning their attitudes and expectations to being asked questions about sex is reported. The majority of patients expected there to be some inquiry about sexual matters. While detailed enquiry was not anticipated, patients stated that most questions would not make them feel uncomfortable. This study does not support the view that patients are reluctant to give a sexual history.

In a nutshell, commissioners (i.e. health authorities) have a statutory responsibility to buy the best health care for a defined population with a defined amount of money. They also have a broader, but less well-defined, responsibility for health, as opposed to health care. There is no doubt that health care has a relatively small influence on health compared with deprivation, housing and unemployment, but in reality the majority of effort of commissioners focuses on health care.

It is important to explore and interpret the dynamics of cultural differences and racism in clinical work. Race and culture often play a significant role in any psychotherapeutic relationship. Vignettes and clinical narratives are used to illustrate that they can be a useful vehicle for the expression of transferences, demonstrating how basic concepts of psychotherapy apply to cross-cultural interactions.

Dutch forensic psychiatry provides services for mentally disordered offenders which centre around a legal measure called the TBS order. Specialised units deal separately with assessment and treatment. The system appears to work in the context of a small and wealthy country and a criminal justice system which differs from the English system. This paper describes the key features of the secure units, examines the conceptual issues and complications of the Dutch system, and considers lessons for psychiatric and legal approaches to the problem of psychopathy in Britain, in particular the new hybrid order.

The Royal Society is the oldest scientific society in Great Britain and one of the earliest in Europe. It is usually considered to have been founded in 1660, though a nucleus had been in existence for several years before that date. From Charles II's reign onwards, British Governments have constantly appealed to the Royal Society for advice in connection with scientific undertakings. The Society elects some 32 Fellows annually, who have been proposed by six or more existing Fellows. Foreign Members, not exceeding 50 in all, may be selected by the Council from among “men of the greatest scientific eminence” abroad. From this it can be seen that Fellows of the Royal Society are among the most distinguished scientists in the country. It is not widely known that several psychiatrists have been Fellows of the Royal Society.

In recent years, psychiatrists have become much more aware of the sexual abuse of adults with a learning disability. Having struggled with such a case, which raised challenging problems of law, ethics and management (Crichton, 1997), I turned to the literature to help inform me about the subject. There I found helpful statistics from recent surveys, but sometimes such material fails to convey the true nature of what is a distressing and painful subject. To my astonishment I discovered that at a local theatre there was to be a performance on this very theme: An Error of Judgement I had heard of the Strathcona Theatre Company, a touring company of eight learning disabled professional actors who, with the assistance of two directors, devise the original plays they perform, but I had no idea of what the evening was going to be like.