There appear to be more posts being advertised for consultants in psychiatry than available suitably qualified applicants. The process of advertising, contacting interested candidates and compiling an information pack is reviewed in an attempt to formulate an ‘ideal approach’.

The Scottish Liver Transplantation Unit (SLTU) opened in the Edinburgh Royal Infirmary in November 1992. We describe the liaison psychiatric input during its first 23 months. Sixty-five patients were seen from 69 referrals and their case notes were studied retrospectively to obtain information on patient demographics and details of each psychiatric involvement. A high level of psychiatric morbidity was found and psychiatric opinion contributed to the transplant assessment procedure. Our results indicate the need for good liaison psychiatric input with subsequent resource implications.

The administration and outcome of electroconvulsive therapy (ECT) were studied retrospectively over two successive periods of 12 months, before and after replacement of our Ectron Series 5 ECT machine by a Thymatron DGx. It was found that using the Thymatron enabled the same outcome of ECT to be achieved, while administering significantly fewer treatments per patient. Possible explanations for this finding are discussed.

An in-patient psychotherapy group was started in an acute female psychiatric ward. Staff and patients were asked to fill in a questionnaire about the group. The response rate was 65% from patients and 58% from staff. The commonest diagnosis was depression. Most patients who attended the group found it helpful. They most frequently valued not feeling alone and being able to talk to others. Staff confidence was low and staff resistance could have contributed to the group being discontinued.

We examined the extent of alcohol misuse among final year medical students and explored their attitudes to their drinking and the drinking of others in order to gain insight into why junior doctors frequently fail to identify alcohol misusers. The questionnaire included AUDIT (Alcohol Use Disorders Investigation Test), personal details and an attitudinal component. Response rate was 92%. Forty-six students (37.8%) scored as alcohol misusers. Teetotallers had a more judgmental attitude towards ‘alcoholism’. Extremes of drinking behaviour among students may affect later patient care.

Frameworks within which services are delivered to people with mental health problems neglect the specific needs of those with dependent children. These children have been identified as having risks to their development and well-being. A system of monitoring social assessments of mental health crisis is used to examine the characteristics of parents assessed in seven Local Authorities across 3 calendar years. Parents of dependent children are underrepresented, and are more likely to be women and to suffer from affective psychosis. Ethnic minorities are over-represented. Parents are less likely to be detained following assessment. Further work is needed to establish whether the needs of the family as a whole are addressed.

This paper describes the establishment of a team of four nurses to provide a service in old age psychiatry along the lines of “Hospital At Home”. Its aim was to treat and nurse patients at home who otherwise would have to be admitted to hospital. An integral part of this initiative is the use of a problem orientated approach with integrated records. The work of the team over six years is reviewed and how it has evolved to provide a rapid response to difficult and fraught situations.

At the Council meeting of the Royal Medico-Psychological Association in November 1963 the Treasurer reported that “a handsome legacy of about £20,000 in shares had been made to the association by the late Dr Blake Marsh and arrangements are being made to take over these shares”. The actual amount was in fact a little over £23,500 – a considerable sum by today's standards. Numerous suggestions were made as to how this generous gift might be honoured including naming the Association's Bronze Medal after Blake Marsh but Council finally accepted a recommendation of the Education Committee “to found an annual lecture of a standing equal to the Maudsley Lecture on a subject connected with Mental Deficiency to be known by his (Dr Blake Marsh's) name” and this was ratified at the Annual Meeting in 1965.

The undergraduate medical curriculum in Nottingham has recently undergone dramatic change in response to General Medical Council recommendations. As part of the changes, the examination procedure in psychiatry has been altered, replacing the clinical ‘long case’ with an objective structured clinical examination (OSCE). The OSCE has long been seen as a valuable assessment tool in more ‘procedure-orientated’ specialities, but its use in psychiatry is not widely reported. This paper discusses the reasons behind the change, the design and implementation of the OSCE, and benefits and problems encountered during its first application.

Hyponatraemia is usually defined as a serum sodium concentration below 135 mmol/1. The condition is rarely symptomatic until serum sodium falls below 120 mmol/1 and symptoms are more usually associated with values around 110 mmol/1. These symptoms include confusion and restlessness, progressing to drowsiness, myoclonic jerks, generalised convulsions and eventually coma. In a general hospital population about 1% of patients develop hyponatraemia (Rutsky, 1992), whereas in psychiatric patients the prevalence has been reported to range from 3.3% to 12.2% (Ohsawa et al, 1992).

Following a series of well-publicised tragedies the Department of Health published guidelines on the discharge and aftercare of psychiatric patients (Department of Health, 1994). These guidelines stipulate that at the time of discharge from in-patient care the treatment team will have carried out a risk assessment, with the expectation that professionals will be criticised if things go wrong. Risk assessment is now a routine, if poorly understood, element of clinical practice. The allied concept of risk management, which lacks a simple definition but is “aimed at reducing the likelihood of harming patients during treatment, minimising trauma to those who are affected, and controlling the possibility of subsequent litigation” (Vincent, 1995), is much less familiar to clinicians. The Editor has commissioned a short series of articles that address the topic of risk in psychiatry, covering suicide, dangerousness, the exposed role of Mental Health Review Tribunals in the case of Restricted patients and a variety of professional risks. The aim is not to be didactic but to raise the level of debate about the risky business that psychiatrists are engaged in.

At a Regional meeting of Members and Fellows of the Royal College of Psychiatrists, held in Cairo in April 1994, a strong initiative to promote Abbasiah Psychiatric Hospital as a teaching centre was put forward. The President, Registrar and Dean made a preliminary visit to the hospital and met with Dr S. Al-Kott, the Medical Director, and agreed to offer assistance on behalf of the Royal College of Psychiatrists. It was anticipated that Abbasiah would benefit through improved recruitment into medical and nursing posts, and by the injection of renewed interest in its large patient population.

“Men at some time are masters of their fates: The fault, dear Brutus, is not in our stars, But in ourselves, that we are underlings” (Julius Caesar. Act I, Scene 2).

“… the cardinal requirement for the improvement of the mental health services in this country, is … a strengthening of the family doctor in his therapeutic role.” – Michael Shepherd (1966).

Junior psychiatrists in the UK often receive only minimal training in psychodynamic aspects of group processes, especially as applied to the understanding of organisational dynamics. Yet these processes may be an important force operating in clinical teams, in both hospital and community settings.

Training in psychiatric work in prisons may not always receive adequate attention, as highlighted in the Reed Report (Department of Health and Home Office, 1992). As a first step in addressing this, a one-day induction procedure has been added to the Induction Programme for the Forensic Senior Registrars at the Regional Secure Unit (RSU) in Bristol. The contents of the programme were determined by discussion among prison medical staff, the Training Department and Forensic Senior Registrars, and are outlined in the following timetable: