Rapid cycling (RC) occurs in up to 20% of patients with bipolar affective disorder and is particularly common in women. It is generally defined as a condition where four or more episodes of (hypo-) mania or depression occur in any year. Frequently, patients with RC switch rapidly between episodes without passing through a euthymic stage. RC is notoriously difficult to treat and the refractoriness of the condition has led to a number of drugs and combinations being put forward as potential therapeutic interventions. This article reviews current treatments and suggests a treatment strategy based on available evidence of efficacy and tolerability.

Psychiatric disorders in the community are very common and most are dealt with by GPs, only a small proportion reaching psychiatrists (Goldberg and Huxley, 1980; Shepherd et al, 1981). It has been suggested that a large proportion of the psychiatric problems seen by GPs are intimately related to adverse life events and difficulties (Ingham, 1981; Tennant et al, 1981).

Idiopathic unconjugated hyperbilirubinaemia (Gilbert's syndrome) is a common benign disorder that, when seen in association with psychiatric illnesses, often leads to the inappropriate withholding of psychotropic medication. We describe three cases with Gilbert's syndrome and psychosis in which diagnosis of Gilbert's syndrome was delayed. This led to unnecessary investigations, further relapses and increased admissions to hospital. We emphasise the need for psychiatrists to be more aware of this benign condition.

This article describes the process of setting up a community support team for the severely mentally ill, and the challenges this posed. As this method of service delivery has been infrequently described, it is hoped our experience may be instructive to others.

Trainees beginning their careers in psychiatry sometimes view research as an additional hurdle that they have to surmount in order to gain senior registrar or consultant status. Conversely, research enthusiasts may see research as an exciting and rewarding activity which enriches and informs clinical practice. The aim of this article is to strike a balance between these two divergent views to help trainees in their selection of the research option most suited to their temperament and aspirations. As a result of our own experiences of full-time and part-time research, in addition to research conducted during full-time clinical posts, we intend this article to be practically rather than theoretically orientated.

The NHS and Community Care Act 1990 has been described as the biggest shake-up to the NHS since its inception. Most psychiatrists will by now be familiar with the new arrangements for community care, but what are the implications of the structural changes in the NHS for psychiatry?

Give or take a few months, it must be 20 years since I led a College Study Tour Group on a tour of Italy, or, to be more exact, of the area north of Rome, economically privileged and steeped in the academic tradition from the Renaissance onwards.

This paper reflects on a special edition of the journal History of Psychiatry and a related symposium held at Somerville College, Oxford, exploring the innovations in mental healthcare in Oxfordshire led by Dr Bertram Mandelbrote between 1959 and 1988. I draw on clinical culture, biography, mental health policy and my lived experience to understand Mandelbrote's life and work, and his legacy and lessons for contemporary psychiatrists. I explore the ecological niche that Mandelbrote created and conclude with the probable importance of his relationship with Professor Michael Gelder, who led the University of Oxford Department of Psychiatry at the time.

As part of the shift towards community care, a number of the large mental hospitals throughout the United Kingdom have now closed and many more are due for closure. In a review of deinstitutionalisation, Thornicroft & Bebbington (1989) concluded that the run-down of hospitals was outstripping the provision of new community facilities. Between 1974 and 1984 the mental hospital population fell by 25,000. However, the increase in residential places provided by local authorities and by the private and voluntary sectors totalled only 3,000. Inadequate planning and provision could give rise to discharged patients facing the prospect of isolated, segregated and impoverished lives with a high likelihood of homelessness and recurrent admission.

Health inequalities in psychiatry are well established, with people living in poverty and those from minoritised groups receiving different care and experiencing worse health outcomes. Psychiatric patients experience significant differences in life expectancy compared with the general population. This article explores changes within psychiatric services and public health interventions that could address health inequalities and asks why this has not happened yet.

Libraries vary greatly: there is a common theme of books and information, but at the edges, one finds all sorts of variations. Examining the range of facilities provided by other College and Institutional Libraries may give us ideas for possible developments in our own College. Such rough statistics as number of staff, number of books held, number of journals taken give basic information. Using this approach, let us look at some of the larger London libraries.

There have been two recent accounts in the Psychiatric Bulletin (Harrison, 1989; Kisely, 1993) which have given some practical advice about getting work in Australia. They did, however, rather gloss over the details. With clear memories of the difficulties of arranging a one year training post in Sydney, New South Wales (NSW) and having been approached by numerous mainly junior colleagues asking about details of arranging a similar trip, I am writing what I hope will be a useful and accurate “Getting your Australian visa and medical registration made easy” guide.