The British National Formulary (BNF) entry for clozapine clearly distinguishes the treatment dose (200–450 mg daily, maximum 900 mg) from the maintenance dose (150–300 mg daily). We looked at 44 patients maintained on clozapine locally and found that 36 (82%) received doses above the BNF guidelines. This has considerable cost implications. While it is always good practice to maintain patients on the lowest possible dose of antipsychotic, the BNF guidelines are not based on objective outcome data, and should be treated cautiously.

Controlled trials show that about 80% of schizophrenic patients remain relapse free when given adequate neuroleptic maintenance therapy but this level of efficacy is not achieved in clinical practice. Guidelines for proper use of neuroleptics in relapse prevention were developed by a group of experienced psychiatrists – the ‘Consensus Group’ – in 1989. In this survey, the views of UK psychiatrists, GPs, CPNs and pharmacists involved in community care of schizophrenia were compared with the Guidelines.

In 1860 the Illustrated London News published an engraving of a male ward in Bethlem Hospital, in which two slightly wary looking whippets or small greyhounds are wandering among the patients, while one of them keeps a watchful eye on a smug cat seated beside the chair of a chess player. At intervals along the walls are birdcages and goldfish bowls, all with their appropriate occupants. Another engraving shows a female ward, where similar cages and bowls can be seen hanging between the windows, though the free-range livestock is absent. Each room is also furnished with a huge aviary reaching from floor to ceiling.

The MacLean Committee was established in 1999 by the Scottish Office to review and make recommendations concerning the sentencing of serious violent and sexual offenders, including those with personality disorder. It provides an alternative perspective on the problem of offenders with personality disorder to that of the Home Office and Department of Health (1999) for England and Wales.

Electroconvulsive therapy (ECT) is an essential treatment for severe mental illnesses such as depression with suicidality and catatonia. However, its availability is being threatened by resource limitations and infection concerns due to the COVID-19 pandemic. This may necessitate the triage of patients for ECT but there is no established ethical framework to prioritise patients. We offer an application of an ethical framework for use of scare medical resources in the ECT setting.

Myanmar, until recently known as Burma, is a developing nation in south-east Asia. Burmese kings and emperors ruled this land until 1885, when it fell into the hands of the British. It gained its independence in 1948. Burma has a mainly agricultural economy and has a rich fertile soil. At one stage in the post-war history Myanmar was renowned as ‘the rice bowl of the world’. It is blessed with abundant natural resources such as teak and precious stones. Myanmar covers a land area twice that of the British Isles with a population of around 42 million.

Data on day time referrals to a liaison psychiatry team from an inner London accident and emergency department (A&E) were analysed over a two-year period. Despite the availability of local community-based alternatives for urgent assessment almost 5000 patients were seen. A quarter were self-referrals and two-thirds had had no previous contact with psychiatric services. The most common reason for referral was aggressive or disruptive behaviour. Characteristics of patients in this inner-city population suggest a continuing need for a high quality liaison service to the A&E department.

As part of testing candidates' abilities, patients are used in clinical examinations for professional qualifications throughout all specialties and levels of medicine. However, the patients' views on being used for these purposes have not been investigated. Examiners use the opportunity presented by candidates interviewing patients in an examination setting as part of the test of a candidate's ability in psychiatry. Psychiatric patients' experiences of such examinations may be so different from that of most clinical practice that there may be profound effects on their views of themselves, their illnesses, hospitals and of the profession itself.

In recent years registrars on psychiatric training rotations have been encouraged to begin their research careers early. Most of them are in such (training posts) for three and a half years. A few with extensive previous experience in other areas of medicine will be in post for less than this. The usual pattern of work with such schemes is to change both posts and accompanying routine every six months. At no point during this time will they have time allocated for research per se unless they are a fortunate member of some of the training rotations which include this in the weekly timetable. Such time has to be begged, stolen or borrowed from the hapless consultant who is all too aware of the service shortfall in his or her own area. If the registrar is fortunate enough to find an accommodating senior, this may not be the situation in his or her next post, which renders long term research well nigh impossible.

The second European Trainees Forum (van Beinum, 1992) met in the Netherlands in March 1993. Training issues were discussed by delegates from the UK, Ireland, the Netherlands, Denmark, Sweden, Norway, Germany, Belgium, Finland, Portugal, and Switzerland. A number of training topics were specifically addressed by the Forum, and a statement unanimously agreed on each of these.

In 1997 there were 57 000 notifiable crimes of serious or sexual violence recorded by police in England and Wales (Home Office, 1998) – more than 1000 per week or approximately one every 10 minutes. On 15 February 1999 the Home Secretary, Jack Straw, announced new measures “better to protect the public from dangerous people in our society” (House of Commons, 1999). He said the measures were to target “those who are capable of committing acts of a serious sexual or violent nature”. Of the 57 000 potential targets, Mr Straw believes 1800 men are already detained in prisons and special hospitals; he intends to identify a further 500 or so men currently at liberty and lock them away indefinitely, in advance of their offending. His intention in respect of the other 54 700 violent or sexual offenders, responsible for 99% of serious violence, is not stated. Mr Straw believes that the 500 men in the community (and the 1800 in custody) share a common psychiatric condition and that this is what makes them dangerous. His policy for identifying the men, and what he intends to do with them and similar people, is contained in the recently published consultation paper on dangerous people with severe personality disorder (Home Office & Department of Health, 1999).

The legal and moral status of the concept of consent are examined. The notion of informed consent as the sole basis for acceptable treatment is found to raise moral difficulties and to have potentially damaging side-effects on the relationship between doctors and patients. It is argued that developing trust between doctor and patient is crucial to obtaining valid consent.