The purpose of this review is to familiarise the reader with the clinical utility of investigations in the diagnosis and management of alcohol use disorders (AUDs). Many biochemical and haematological tests are widely available, and can improve significantly the quality of diagnosis and management. However, there is no single test that can detect AUDs with complete accuracy. Further, the validity of a test will vary depending on the clinical application. Such tests should never be relied on in isolation. Adequate clinical evaluation also needs to include a combination of interview and examination of the patient, and interview of other informants (Cantwell & Chick, 1994; Edwards et al, 1997). In the research setting, self-report is generally a valid and reliable method of assessing alcohol consumption (Babor et al, 1987), particularly when it is elicited by a standardised method (e.g. Sobell et al, 1980) and the information is provided in confidence. In the clinical setting, however, the patient may report his or her version of past drinking subject to the demand characteristics of the situation, particularly if adverse consequences are likely to ensue (e.g. discharge from a treatment programme).

Eye movement desensitisation and reprocessing (EMDR) was described by Shapiro (1989a,b) as a new method for treating post-traumatic stress disorder (PTSD). In May 1987, while walking in the park, Shapiro noticed that her own disturbing thoughts changed then disappeared “without any conscious effort” (Shapiro, 1995) when they had been temporally paired with diagonal upward to and fro eye movements. Over the next six months Shapiro worked with approximately 70 people to develop a procedure based on the temporal pairing of distressing images and thoughts with various eye movements. Shapiro began to develop strategies to unblock stalled emotional processing, which was initiated by EMDR in non-patients. She successfully tried the method on a Vietnam veteran suffering from severe PTSD and then embarked upon a trial of EMDR on a mixed group of victims of rape, molestation and Vietnam combat trauma. Initially, EMDR achieved wide recognition as a new breakthrough treatment for PTSD. This was, in part, because of very positive early reports (e.g. Wolpe & Abrams, 1991), but also because the EMDR effect appeared to occur with unprecedented speed, often in cases of PTSD that had previously resisted treatment by many other methods over a long period.

Dreams have been described as “an endangered species” in general psychiatry nowadays (Holmes, 1991). Liam Hudson (1985) suggests the danger derives from a society which has embraced a naïvely reductionist, oversimplified understanding of neurophysiology. But Hudson also sees a threat to dreams from the increasing variety of visual imagery available for personal creative adaptation through television, computer programs and video recording. Researching this article, I was unable to find a single reference to dreams in the British Journal of Psychiatry over the past 12 years. Theories about dreams are taught to trainee psychiatrists as historical background. In recent years there has been a revival of psychiatric interest in only one kind of dream –‘flashbacks' of traumatic experiences as a feature of post-traumatic stress disorder.

The aims of this article are to provide guidance on how to facilitate small group teaching and to address ways in which learners can be actively involved in the small group setting.

Hormones are widely considered to cause powerful psychological effects and because of this psychiatrists may be asked to advise general practitioners, consultants in other specialities or patients about the relationship between hormones (including sex hormones) and psychiatric disorder. Sex hormones may be relevant to psychiatry in three ways:

(a) Sex hormones may play a role in the pathophysiology of psychiatric disorders.

(b) These agents may be utilised for treatment of psychiatric disorder.

(c) Administration of sex hormones may cause psychiatric side-effects.

The occurrence of depression in people with learning disability is not a late-20th century phenomenon. Reports were first published in the 1800s describing the existence of depression in individuals with intellectual impairment (Clouston, 1883). However, as we enter a new millennium, the appropriate diagnosis, assessment and treatment of depression, and indeed all forms of mental illness in people with learning disability, will become the focus of considerable concern for all professionals working in this field. With recent national trends towards de-institutionalisation, referral of individuals with learning disability to psychiatrists to ‘rule out a possible depressive illness' and to ‘advise about further treatment’ will increase. It remains essential for all psychiatrists in learning disability to continue to improve their diagnostic skills to better manage depressive episodes and, where possible, to learn how to prevent a future relapse. This review highlights the important presentation and management issues relating to depression in the field of learning disability. Depression in this review implies a single major depressive episode, irrespective of whether or not it conforms to any given classification system.

“The psychiatric aspects of ageing are a major problem in any country which, like our own, has a low net reproduction rate and a high standard of social responsibility. The proportion of old people in the community steadily increases so that they provide an increasingly high proportion of our mentally infirm who must be cared for”.

Dental disease and psychiatric illness are among the most prevalent health problems in the Western world. While the dental needs of mentally ill people are similar in type to those in the general population (Markette et al, 1975) there is some evidence that patients suffering from mental illness are more vulnerable to dental neglect and poor oral health (Stiefel et al, 1990; Armstrong, 1994). Sims (1987) reports that physical health problems are more common in psychiatric patients. They seem to be poorly recognised by psychiatrists, and oral health is no exception (Hede, 1995). Oral health is an important aspect of quality of life which affects eating, comfort, speech, appearance and social acceptance (Nordenram et al, 1994).

Behaviour therapy, namely exposure and response prevention, has for many years been the treatment of choice for most patients with obsessive—compulsive disorder (OCD). However, at least 25% of patients with OCD refuse exposure and response prevention or drop-out early. Of those who do comply, about 75% make reasonable gains and maintain them in the long-term. This means that 50% of patients who are offered treatment by exposure and response prevention either refuse, drop-out or show little improvement. Many patients find exposure distressing and this is probably the main reason for dropping-out early. Treatment failures tend to be associated with a depressed mood, over-valued ideation, slowness, mental compulsions and severe degrees of avoidance.

The dramatic development of cognitive–behavioural therapy (CBT) over the past 30 years, with associated high-quality research into the evaluation of its treatment effects, is to be welcomed and applauded. This form of therapy is now a recognised psychological treatment of choice for a wide variety of psychological disorders. The role of cognitive processes in the development and prolongation of psychological symptoms has been studied, and resulted in the development of coherent and effective treatment models.

As psychiatrists, we are responsible for large numbers of patients who require follow-up over years, and often lifelong. Usually these patients suffer from chronic psychotic illnesses, and their psychiatrist may be their main point of contact with the medical profession. As a group they face a whole range of problems – not only from the psychiatric condition itself, with its associated stigma and psychosocial stresses, but also from unemployment, poverty, poor housing and worse physical health.

This review will look at the evidence that patients in continuing care have increased morbidity and mortality. The types of illness excess will be examined and explanations suggested as to why such an increase exists. Finally, we present practical steps that might usefully be taken to reduce physical illness and premature death in this vulnerable group.

Medical undergraduate training is currently going through a momentous period of change (Tosteson, 1990). New methods of learning and evaluation are being introduced which will radically alter medical training over the next few years. These changes are in part a response to the way medicine itself is being transformed. Medical educators can no longer hope to equip medical students, upon qualification, with enough basic knowledge and skills to last them throughout their medical careers. Today's students are embarking upon a process of learning which will continue throughout their medical lives. Medical practice will be very different, when today's students become tomorrow's hospital consultants and general practitioners.

British psychiatry is appreciated all over the world for its empirical approach, its basis as a publicly funded service which is available to all citizens, and for its tradition (shared with the rest of British medicine) of educational connections with many other countries – members of the Royal College of Psychiatrists can be found in 70 countries worldwide. These connections are educational for all of those concerned. For visitors, the experience of seeing what can be done in a different context with different resources – both human and material – compels them, on their return home, to see their usual territory and practice in a new and revealing light.

The publication of Tomorrow's Doctors(General Medical Council, 1993) opened our minds to the need for a more thoughtful and evaluated approach to education in medicine. The expansion of medical knowledge has shown no sign of slowing, which makes it imperative that we find ways to prioritise and organise what we teach so that students are given a clear structure. Learning objectives are one of the building blocks that give order to what we do with and for our students.

Twenty-four-hour nursed care refers to a model of psychiatric care which in fact varies quite significantly from unit to another. This sort of residential care unit has also been called the “hospital hostel” (Goldberg et al, 1985), “ward in a house” (Wykes & Wing, 1982), “psychiatric nursing home” and in some cases “staffed group home”. Although the unit size, staffing structures and ratios, and the degree of direct management within the National Health Service (NHS) vary, this model of care has some quite specific characteristics, which have been summarised by Shepherd et al (1994) as follows:

The origins of the probation service can be traced back to the late-Victorian era and the introduction of the so-called police court missionaries who supervised offenders on conditional release from the court. The service grew slowly, but mushroomed in the 1970s and 1980s when several major acts widened the scope of the service by introducing parole, aftercare of discharged prisoners, community service by offenders, and extended the scope of probation and bail hostels. Since the beginning of this decade the probation service has been working in an ever-changing legal and philosophical context. Public protection and the prevention of crime are our primary aims. Legislation and ministerial directives have necessitated increasing involvement of probation offices in work with offenders with mental disorder, and have brought into greater focus the relationship of the probation service with psychiatry.

Those contemplating research in developing countries should bear in mind the following: the collective wisdom of both foreign and local investigators should be pooled to determine the most appropriate research questions and ethical obligations. Several collaborative research programmes launched by the World Health Organization (WHO) have shown that it is eminently possible to engage in high-quality cross-cultural research, and many of these studies have generated a wealth of data from developing countries. Rigorous and highly sophisticated studies are possible in the developing world (Wilson, 1990). At the Schizophrenia Research Foundation (SCARF) we have had several opportunities to collaborate successfully with researchers both within and outside India (Eaton et al, 1995; Thara & Eaton, 1996). This success has largely been due to mutual respect for one another's expertise and role with no room for patronisation and condescension.

Recommendations by Lord Woolf for the reform of the civil justice system in England and Wales include proposals which are already beginning to influence the provision of expert evidence to the courts. Lord Woolf has himself been instrumental in the establishment of an Expert Witness Institute which has caused some controversy in medical circles. It is no coincidence that all of this is happening at a time when the courts are delivering judgments which are particularly critical of some expert witnesses.

Since the 1970s, there has been a progressive increase in the use of computers as a teaching resource. The purpose of this article is to summarise the current uses of computer-based learning (CBL) packages and to highlight how to assess whether a particular multimedia package meets your own requirements for training.