A postal questionnaire concerning the management of cognitive impairment of vascular origin was completed by 88 psychogeriatricians and 100 geriatricians. Aspirin was considered an important part of management, and clinically indicated with: a history, or clinical signs of stroke; computerised tomography (CT) scan changes suggestive of cerebrovascular disease; and atrial fibrillation. Advanced dementia was seen as a contraindication for treatment. Eighty per cent of responders indicated they would institute antihypertensive therapy in an elderly patient with a history of raised blood pressure and cognitive impairment. The median lower limit of systolic blood pressure requiring treatment was 160 mmHg, with a treatment target blood pressure of 150 mmHg.

Liaison with the various agencies which deal with mentally abnormal offenders is one of the prime roles of the forensic psychiatrist (Royal College of Psychiatrists, 1988). The probation service is a key agency in this regard. The importance of such collaboration has once again been highlighted with the clear message that the care of the mentally abnormal offender is improved as a result (DOH/Home Office, 1991). However, the provision of a satisfactory psychiatric consultation service to probation clients who have been remanded on bail can be problematic. Much of the work of forensic psychiatrists is institutionally based. Non-attendance rates at hospital based out-patient clinics are high (Bowden, 1978). However, general psychiatrists have found that psychiatric clinics based in general practitioners' surgeries are more acceptable to patients than hospital clinics (Tyrer, 1984). The probation office as a community base for forensic psychiatrists is a valid equivalent.

Clinical supervision of counselling and psychotherapeutic work performed in a district general adult psychiatric service is examined. Most staff received regular supervision, usually having more than one source of supervision. Paired peer supervision, within a discipline, was the commonest structure. Supervision was mainly focused in two areas, on interventions made by the therapist, and examining the therapeutic relationship. Most staff had confidence in their supervision, but those who had not discussed a supervision contract were significantly less likely to be satisfied with their supervision.

A controlled study of community care in serious mental illness (SMI) was carried out. Patients with SMI were randomised to have hospital care or be looked after by a community psychiatric care team in a Daily Living Programme (DIP). The day-to-day work of a clinical team with the difficulties encountered in delivering community psychiatric care in an inner city is described. There were seven deaths from self-harm during the 45-month study. One DIP patient committed homicide. An ordeal by media following this and the suicides are described. Lessons learnt include the need for the community care team to be responsible for discharge from any in-patient phases and for attention to team morale, especially during adversity, and to time spent working under pressure.

What follows is concerned with the role of the consultant. To avoid stereotyping of gender or race, this consultant will henceforward be referred to as she and should be considered as of minority ethnic origin.

It is important to explore and interpret the dynamics of cultural differences and racism in clinical work. Race and culture often play a significant role in any psychotherapeutic relationship. Vignettes and clinical narratives are used to illustrate that they can be a useful vehicle for the expression of transferences, demonstrating how basic concepts of psychotherapy apply to cross-cultural interactions.

Previous audit of electroconvulsive therapy (ECT) standards has identified deficiencies in service provision. Little national information was available on ECT services in Scotland. Survey questionnaires were sent to all consultants in charge of ECT clinics in Scotland. There was a 100% response rate. The service provision varied across Scotland, and in some cases fell below Royal College of Psychiatrists' recommendations. There now exists a base of information on services available and an ongoing national audit system should be considered. Several recommendations have been made for the future of ECT services in Scotland and these have been distributed to consultants in charge of clinics.

The weekly educational supervision sessions between consultant psychiatrists and their trainees have emerged as a central pillar of psychiatric training. The College has set out, in various Statements on Approval of Training Schemes for General Professional Training for the MRCPsych, what it expects of these sessions: they should happen weekly, be devoted entirely to the needs of the trainee, and be applied to the development of the trainee's clinical skills as opposed to academic knowledge.

There is an increasing body of research literature investigating the effects of parental mental illness on children. This study investigates the views of psychiatric in-patients on consequences of their admission to hospital and their mental illness for their children. The results suggest that the parents do not readily acknowledge that their children have problems, and that interventional approaches require good liaison between adult mental health services and child-focused agencies.

A client held record for patients with long-term mental illness was introduced by a community mental health team in east London. The record was evaluated by asking the opinions of 45 patients and examining how their client record had been used. Over 80% of the patients found the record and the information it contained useful, 74% of contacts were recorded in the booklet and the client held record had begun to be used by many professionals for purposes other than appointments and medication. A client held record can increase patient involvement in care and help communication between professionals.

Patients waiting for psychotherapy show high levels of morbidity and distress from psychiatric symptoms and a high frequency of personality disorder diagnoses. They constitute a group at risk of completed suicide. Local NHS provision is less than half the minimum amount of treatment needed.