Vienna, a city with a population of 1.5 million, as well as being the capital of Austria is also one of its nine provinces. Care for the mentally ill in Vienna, as elsewhere, was for decades either misguided or poor. The large mental hospitals in the city were seriously overcrowded and understaffed. In the extramural sector, there was an enormous deficit in out-patient and complementary facilities.

With the rapid expansion in the number and variety of psychotherapy courses in this country, it is perhaps timely to review some of the issues influencing these courses. One purpose of this paper is intended to draw attention to the fact that not only are there interesting conflicts in establishing such courses but also establishments whose power relationships affect the educational effectiveness of these complex teaching ventures. These issues will be discussed with reference to the trainees, trainers, patients, and host organisations.

Previous studies have looked of repeated admissions and failed discharges but none have followed up a group of patients requiring multiple admissions over several years. We found that of the 42 patients admitted three or more times to acute wards in 1990, half were having a bad year and did not require this level of inpatient care in succeeding years; one-quarter continued to use acute services heavily but none required three or more admissions in every year of follow-up; one-quarter did badly and required prolonged in-patient care or died.

I have spent all my professional life as a child psychiatrist working in hospitals and clinics. For many years I have been interested in helping bereaved children and conducted research on how best to help them. As the result of my interest I found myself being asked to see increasing numbers of children who were traumatically bereaved because of one parent killing the other, an event that the children often witnessed. I needed to familiarise myself with the effects of witnessing or being caught up in severe trauma, as well as the effects of bereavement. As I saw more and more of these traumatically bereaved children, I realised that child psychiatric services were not well organised to help these children who often needed emergency help. I decided, with the backing of the Royal Free Hospital, to retire from my post as head of a busy department and set up a clinic for children who had been acutely psychologically traumatised. This work is now supported by a grant through Cruse-Bereavement Care from the Department of Health. I wanted to see how others had organised services for such children so I applied for and was granted a Winston Churchill Travelling Fellowship to study trauma services for children in the USA. I spent a month visiting San Francisco, Los Angeles, Boston, New Haven and New York in September 1993.

This editorial expands on a Praxis article published by Beattie and colleagues in the trainees’ section of this journal. The authors describe an interesting case of anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis, outline the clinical presentation and make suggestions on ways to approach this rare disorder. Here we provide an overview of autoimmune conditions that result in the production of autoantibodies targeting central nervous system proteins mediating autoimmune encephalitis and offer a perspective on approaches to diagnosis and treatment.

In common with other psychiatric units throughout the land, we have been struggling to come to terms with the Government directives regarding the Care Programme Approach. A great deal of time has been spent attempting to devise a system which is workable and useful but which might leave some time for face-to-face contact with patients; implementing it forces the psychiatrist into a catch–22 situation. If things are seriously wrong for a patient, the psychiatrist could be criticised for not putting somebody on CPA, or criticised for putting them on it but not carrying the process through thoroughly enough. In spite of this, I have participated in the scheme, if only because the consensus would seem to be that it is necessary to have the system in place, mainly as a defensive measure or in the hope of ensuring adequate resources. My overwhelming feeling, however, has been that it has been a time-consuming way of formalising good practice, and that the time spent filling in the forms would be better spent talking to the patients. I have always felt uncomfortable listing needs and solutions with the patient and ‘the team’, because it seemed reductionist, but I thought that this was my idiosyncratic response, and that I should get on with it. Recently, however, there was a near disaster with a patient which served to strengthen my reservations.

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 concept of multidisciplinary care has arisen from the recognition that there are many areas in medicine and psychiatry which require professional skills and expertise in addition to those possessed by doctors and nurses. The attitude of psychiatrists towards this development has varied from enthusiasm to alarm. Whereas the latter may be understandable in the face of recent publications which portray the profession as being under threat, Bennett (1988) has addressed these changes in a positive manner, and it is surely more responsible to regard the emergence of related professions as a source of assistance rather than hazard.

Over nine months, 57 consecutive newly referred and previous out-patient attenders to two community psychiatric out-patient clinics located in a deprived inner city area of London were interviewed to elicit demographic information, psychiatric details and obtain their views about their preferred location for the out-patient clinic. The majority (94%) preferred a community out-patient setting to a hospital out-patient clinic, with 76% preferring a community out-patient setting to a home assessment. The overall attendance rate was 89%. A 10% higher rate of attendance was found at the community mental health centre compared with the general practice and 15% higher rate for new referrals. Patients preferred to attend a psychiatric out-patient clinic based in the community. This suggests that introducing community-based psychiatric clinics would make a substantial improvement on the current high rates of non-attendance at hospital psychiatric out-patient clinics.

The behaviour of X in childhood had been described as ‘difficult‘, ‘aggressive’ and ‘bizarre‘, including bizarre gestures, mannerisms, ‘making scenes in public‘, ripping her clothes and trying to set fires.

A recent survey of the views of clinicians at St George's Hospital on the content of the psychiatric formulation (Hollyman and Hemsi, 1983) revealed much diversity of opinion and confirmed our hypothesis that the notion is open to different interpretations. It seemed appropriate therefore to conduct a similar survey of College Examiners to discover whether there is similar variation in that group.