Journal clubs have traditionally been important means by which clinicians, academics and trainees appraise research that relates to their field. In recent years the evidence-based style has become more prevalent, allowing knowledge gleaned from research to be applied to clinical situations. Currently, the main approach of evidence-based journal clubs is quantitative. This paper describes the evaluation of a modified journal club format, developed in an academic department of a medical school and combining the appraisal of both qualitative and quantitative papers.

Medium-secure care services developed in England following the Butler report (Home Office & Department of Health and Social Security, 1975). They were established to address the major gap in provision between high-secure and local mental health services. However, the development of special secure services for offenders with a learning disability has largely been neglected (Snowden, 1995). People with learning disability who require secure in-patient care are often placed in remote and costly units because suitable local facilities do not exist. Such placements do not usually accord with user and carer wishes.

Thirteen per cent of referrals of ex-servicemen to a military psychiatric centre for the treatment of combat-related post-traumatic stress disorder (PTSD) in a 12-month period have proved to be factitious. A simple classification of factitious combat-related PTSD into those with no military service and those with military service but with false claims of combat is described. The possible causes of this behaviour are discussed and a guide to the detection of factitious claims for psychiatrists without military experience is given.

A hundred and fifty years ago, physical disease was known to be widespread but was usually untreated. Anxiety and depression is now like that. Up to a fifth of the entire population are affected, of whom 84% were untreated in a UK community survey (Bebbington et al, 2000). ‘Developed’ countries are underdeveloped when it comes to treating anxiety and depressive disorders, even though effective treatment is available in the form of brief cognitive–behavioural therapy. In the UK, waiting times for such therapy can be as long as 2 years. Routine therapy outcomes are rarely reported. The delivery and monitoring and also teaching of therapy still largely conform to a 19th century model, and could be advanced by greater use of information technology. Such technology could catalyse a model of community care delivered mainly in the home, by enhancing access to effective self-help, audit of outcome and professional training.

The pharmacological management of acute behavioural disturbance in psychosis is not straightforward. The real, or perceived, dose:effect relationship of the various neuroleptics in common use has an important influence on prescribing patterns leading, in certain situations, to very high doses of neuroleptic medication being prescribed. Data from a study of the use of neuroleptic medication in two psychiatric intensive therapy units illustrate the potential extent of the problem. Over half of the cases were not amenable to accurate dosage monitoring due to the use of depot neuroleptics, Clopixol Acuphase or polypharmacy. The majority received doses exceeding the limit suggested by the British National Formulary. Efforts to standardise the use of such drugs would help to optimise the clinical management of this challenging group of patients.

The new Mental Health Act for England and Wales is likely to extend the powers of mental health review tribunals (MHRTs) by giving tribunals the power to approve all compulsory treatment (Department of Health, 1999a, b). The medical member may be dropped entirely from the tribunal's proceedings (Richardson & Machin, 2000). In Ireland, a proposed new Mental Health Act will introduce MHRTs for the first time (Calvert, 2000). The 1983 Mental Health Act contains no explicit statement of underlying principles, although some were introduced in the revised Code of Practice. The Expert Committee (Department of Health, 1999b) suggested that the new Act should specify broad principles where these would help in statutory interpretation, particularly because a range of practitioners working in different settings will be required to understand and implement its provisions. The Green Paper initially suggested that the proper place for setting out principles should be a Code of Practice, but ended by inviting comments on the principles proposed by the Expert Committee, and on whether inclusion of principles would aid interpretation of the new Act.

Contempt is one of the more important signs of hubris syndrome. Lying to Parliament or the courts is often a sign of someone in thrall to hubris. In business and banking, collective or corporate hubris is not uncommon as is hubris syndrome among its most powerful leaders. BP, RBS and HBOS need to be the subject of serious case studies for hubris, ‘group think’, tunnel vision, closed minds or silo thinking. There are indications of a neurobiological explanation for the intoxication of power in hubris syndrome.

A working party of the Collegiate Trainees' Committee of the Royal College of Psychiatrists sent a questionnaire to all trainees taking Part II of the MRCPsych examination in October 1992, asking about their satisfaction with various aspects of their training. Almost 70% rated their training as ‘good’ or ‘excellent’, but specific areas showed wide variation. Cognitive/behavioural psychotherapy, family therapy, research, the management of dangerous patients and the use of ECT were all highlighted as areas in need of Improvement. The working party make recommendations in the light of these findings.

Despite the recommendations of the Health Advisory Service report Bridges over Troubled Waters (1986), there has not been any dramatic growth in adolescent psychiatry as a sub-speciality. The HAS report highlighted the largely unmet special needs of this age group, the rising risk for mental illness with increasing age in adolescence, and the need for effective liaison between professional disciplines working with this age group. Nevertheless adolescent services increasingly perceive themselves as under threat from political initiatives and continue to fight their corner (e.g. Wells, 1989).