This short review outlines the clinical profile of the selective serotonin re-uptake inhibitors (SSRIs). There has been much recent publicity and promotion of this group of drugs and this review attempts to give a balanced account of their current place in the treatment of depression. Although a large number of preclinical and clinical trials have been carried out many questions and problems remain – it is important to proceed carefully and carry out (and replicate) controlled independent clinical trials. The views of general psychiatrists and GPs about these drugs in normal clinical practice will be the acid test – this will be particularly important in view of their cost.

Old age psychiatrists' main concern with regard to incapacity is with patients with dementia. Dementia is predominantly a disorder of old age, probably affecting over half a million people in the UK, and it inevitably affects decision-making capacity. The 1983 Mental Health Act does not appear to have been framed with particular consideration for this group and it is vital that any new laws pay special attention to people with dementia.

Many patients with persistent mental illnesses enjoy a better life in a community setting than would be possible in a long stay mental hospital. Furthermore, the available evidence indicates that most such patients get better while living in the community. Unfortunately, community care has not served all patients well. Much of the difficulty can be attributed to lack of resources. However, there is also a tendency by planners to underestimate the severity of patients' disabilities. A realistic appraisal demands a detailed examination of the problems of patients whose needs have not been met by community care. One important issue is that of patients who fall through the net of community care and another is that of patients who have not but nonetheless have not survived in the community. This paper addresses the question of the needs of this latter group.

In 1991 we predicted the new contracting system introduced by the NHS Bill would reduce referrals to specialist units, particularly supra-regional units (Dolan & Norton, 1991), and that any resulting decline in patient numbers might lead to the suggestion that these resources were surplus to requirement and hence not viable in a market economy (Dolan & Norton, 1990).

There is widespread recognition that many who seek or are referred for help to psychiatric and social services are acutely disturbed and require only short-term help if they are to come through a period of transient disruption in their lives. The frequency with which people in crisis consult their GP or visit a local Social Service Department is uncertain but suggests that the primary carers are the first port of call for most of them. Services developed to meet the needs of these people include traditional GPs and psychiatric services directed primarily at ‘patients’ (people who meet criteria for illness), but which often offer additional help to their families; traditional social services which place no such limitation on the individuals who seek their help but are directed mainly at people with problems in living, particularly with housing, employment and money; and counselling and advisory services (such as Relate – formerly Marriage Guidance) which focus on particular problems or client groups. A few special crisis services, most of which provide a multidisciplinary team, visit clients in crisis in their homes. These are usually psychiatric services for patients with acute mental illness (Cooper, 1979).

There are many kinds of crisis service. Most are open only to people who have been diagnosed as mentally ill. They facilitate rapid admission to short-stay in-patient services with the back-up of multidisciplinary teams working in the community. Others attempt to keep patients out of hospital by providing support to patients and their families in the community. Several have demonstrated striking reductions in the rate and duration of hospital admissions without detriment to the subsequent health or social adjustment of the patient.

In ‘Leonardo Da Vinci and a memory of his childhood’, Freud (1910) provided an analysis of the artist's personality and sexuality, with a description of his capacity to sublimate his libido into creative works. He discussed the Mona Lisa's ability to command attention and induce differing emotions within the viewer. In his paper he described the distinct elements of her expression, “The contrast between reserve and seduction, and between the most devoted tenderness and a sensuality that is ruthlessly demanding – consuming men as if they were alien beings”.

As community services develop, medical staff are increasingly spending more time outside the hospital, despite the most severely ill patients still being in hospital. This may lead to junior medical staff and nurses feeling unsupported by the consultant. In addition, as more disturbed patients are kept out of hospital, the general practitioner and community health workers may require to contact the psychiatrist more often to talk about patients or to request urgent assessment. Therefore the importance of communication with consultants is increased both from the hospital and from the community while they are spending increasing amounts of time in their cars. In a discipline where communication is of paramount importance, a failure to meet this growing need would undermine the effectiveness of the service as a whole.

“Here is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head, behind Christopher Robin. It is as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it.”

Section 5(2) of the Mental Health Act, 1983 allows for the detention of an informal in-patient, should he/she wish to leave hospital but be considered a danger to him/herself or others if allowed to do so. The 72 hour period of detention allows time for a completed assessment for application for admission under Section 2 or 3 of the Act; it is not intended to replace this fuller assessment. The 1983 Mental Health Act introduced new provisions with regard to Section 5(2). The equivalent Section 30 of the Mental Health Act 1959 did not provide for a nominated deputy to act on behalf of the registered medical practitioner in charge of the patient's treatment (RMP). The nominee must exercise his/her own clinical judgement but, as indicated in the Code of Practice (1990), must contact the nominating doctor or another consultant to discuss the need for Section 5(2), before implementing it. The nurses' holding power, Section 5(4), was also a new provision in the 1983 Act.

At most conferences on medical audit we are reminded that medical audit is centuries old. What is new is the push for medical audit as a formal activity in which each clinician must take part. This push came from Mrs Thatcher's NHS review in 1989, invoking the spirit of market forces in the NHS. Whether this spirit is that of a goddess or demon, it is perhaps too early to know. As many of the Royal Colleges (Hoffenberg, 1989; Royal College of Psychiatrists, 1989; Royal College of Surgeons of England, 1989) and the Standing Committee on Postgraduate Medical Education (1989) produced their guidelines, the push to make medical audit a formal activity in which each doctor should take part became reality in 1989.

The College library is continuing with its project to photograph some of the large old psychiatric hospitals. With the planned closure and possible demolition of many of these institutions it seems worthwhile to record the architecture of the buildings, although inevitably most have been extended, renovated or dissected over the years. Initially hospitals in the vicinity of London are being photographed but we hope to include establishments throughout the country and would be pleased to receive photographs of any architecturally interesting psychiatric hospitals to add to our collection. (Photographs on this spread by Mr C. Priest/MAGPIE Reprographics.)

On Saturday, 9 March 1991, I had a great fall. I think I'd been heading for it for a year or two – rushing endlessly and never quite catching up. I was just back home from the Section for the Psychiatry of Old Age's meeting in Chester. I hurried downstairs and lost my footing. My right leg shot suddenly down seven or eight stairs, leaving the left behind; I didn't even make the bottom of the staircase. The pain, swelling and distortion clearly indicated something more than a sprain. My first thought was of my appointments diary, crammed for the next two months. My second was “I hope I don't get a DVT!”

Single issue political movements (such as feminism, anti-racism, Marxism, homosexual liberation, animal rights etc) have been a major characteristic of the post-1960s radical scene in the United States and Western Europe. While such movements typically start out doing a good job, it is my assertion that they have now reached the point of posing a serious threat to medicine at large, and to psychiatry in particular.

Most medical researchers rely on computers to store their data, often many years of work. It is, however, surprising that many give little thought to protecting their machine from malicious damage caused by computer viruses. This article examines how to prevent, detect, and remove computer viruses.

In recent years there has been increasing concern about the plight of the mentally ill in prisons, particularly those on remand. The 1976 Bail Act gives everyone the right to unconditional bail but mentally disordered offenders find themselves disadvantaged in that their right to bail can be set aside not only because of the gravity of the alleged offence but also for reasons consequent to their mental illness. These include lack of community ties, their own protection or most commonly for the preparation of psychiatric reports. The mentally disordered may thus be remanded in custody even if the charge against them is minor or not punishable by imprisonment.

It has for many years been the custom for nations to commemorate their heroes and heroines by placing their features on bank-notes. Among these are four psychiatrists whose brief biographical details are given below.

The rotational training scheme now forms the basis of psychiatric training. The advantages include the provision of experience in a wide variety of posts, while permitting educational continuity as well as the stability that accrues from having a job over a long period of time. Achieving a Balance threatens to change the structure of the rotation and thus the very nature of psychiatric training. The main consequences are the division of combined rotations into separate senior house officer and registrar rotations, competitive interviews for registrars, and the expansion to multi-district rotations.

This paper describes the work of a family therapy team which includes a senior house officer, or registrar, and discusses how such experience is of value to the trainee in general adult psychiatry.