Although there seems to be a shared impression that the proportion of women in academic psychiatry is substantially lower than in National Health Service (NHS) posts, we are not aware of any empirical data on this. In the USA, women physicians have been shown to be more likely to pursue an academic career than men (Nonnemaker, 2000), but the number who advance to Professor appears significantly lower than expected (Reiser et al, 1993; Nonnemaker, 2000). Women in academic psychiatry in Canada also appear less likely to advance to senior positions than their male colleagues (Penfold, 1987). A recent survey of 44 academic institutions in the UK, carried out by the National Centre for Social Research (Blake & La Valle, 2000), found that women occupied lower grade academic posts than their male counterparts and therefore were less eligible to apply for project research grants. Those that were eligible were as successful in gaining funding as their male colleagues.

Trainees in psychiatry frequently employ rapid tranquillisation (RT) measures. In this study we surveyed trainees as to RT regimes used. We found that a variety of drugs were chosen. On 45 (46%) occasions one drug was used, on 53 (54%) a combination. Drugs were administered in intramuscular form in 88 (90%) incidents. Zuclopenthixol acetate was prescribed on a total of 45 (46%) occasions. In 38 (39%) incidents the trainee used a high-dose regime. The literature regarding RT indicates inconsistency in practice. We address the reasons for this and make suggestions as to possible improvement in practice.

Homicide is in the news and community care is being blamed, a view not justified by the facts. Much has been written about the homicides of Johnathan Zito and Georgina Robinson and there has rightly been considerable public and professional concern. There have been other reports on the murder of Johnathan Newby in October 1993 and William Bennett in July 1994. Yet another case is currently the subject of an inquiry and again the press is expressing indignation and horror. The anxiety and concern are natural but the reactions are not justified.

Good communication between general practitioners (GPs) and psychiatrists is important. An audit of new patient referral letters from GPs and the first assessment letter in reply from psychiatrists found that GP letters were short (mean 106 words) with limited information which increased with letter length. Psychiatrist's letters were longer (mean 849 words), of a high quality but with a negative relationship between length and information score. Use of the ‘preferred’ format derived from previous research was associated with shorter letters of higher quality. Communication between GPs and psychiatrists might be improved if GPs wrote more and psychiatrists wrote less.

Psychiatric training in all European Union (EU) Member States complies with the relevant Council Directive 93/16, permitting free movement of specialists within EU borders. This assumes that the training offers similar experiences, and produces specialists fit for purpose in all EU countries. Surveys demonstrate that, although all countries adhere to the conditions of the Directive, the diversity of training is striking on all but the most fundamental aspects. An added complication is that psychiatric practice has become increasingly diversified, even between neighbouring countries, and psychiatric training will have evolved to meet national service requirements. Questions about how to safeguard competence of psychiatric specialists to practice across the EU are therefore pertinent, and introducing systems to regulate quality control of training should be considered.

Drug and alcohol misuse during pregnancy poses a threat to the health of both the developing foetus and the mother yet this complex clinical problem often falls between different stools within the health services. A mother would first have to recognise herself as a drug or alcohol misuser needing help before she came within the ambit of the addiction services. On the other hand, the obstetric agencies, even when they identify a drug problem, usually do not regard themselves as having a role. General practitioners are most likely to have an overall view and therefore to be in the best position to manage the problem. However, many misusers do not register with GPs and, despite calls to the contrary, GPs have not become more widely involved in the management of addiction.

Circumstances surrounding emergency detention under the Mental Health (Scotland) Act were examined, with particular regard to whether consent was obtained from a third party. Twenty-eight ot 100 consecutive detentions occurred without consent. These patients were more likely to exhibit aggressive behaviour and be detained by a psychiatric registrar or senior registrar. Mental disorder was doubted more often and detention was less often continued. Reasons given for failing to obtain consent were frequently inadequate and possible explanations are discussed. Increased education and supervision of trainees resulted in a substantial fall in cases of non-consent in a follow-up sample.

The consensus statement by the Royal College of Psychiatrists recommended that patients on high dose antipsychotic medication receive regular electro-cardiographic monitoring to identify prolongation of the QT interval. A survey of trainee psychiatrists in three hospitals investigated the accuracy with which trainees could identify this abnormality and found only 20% could do so.

Our moral conception of suicide is examined. It is argued that a neutral definition of suicide is difficult to achieve and that how we treat the Question of suicide shows what value we place on the sanctity of Me or on life as a means to other ends. The case is made that autonomy, the principle of self-governance, has acquired special importance in the modem world to me detriment of other ethical principles such as beneficence.

A majority of psychiatrists embark on their careers by entering an SHO/registrar rotation where they can expect to receive a broad based training in the principles and practice of their chosen specialty. These posts should provide the trainee with an opportunity to observe and emulate high standards of clinical care as well as fostering academic interests and research skills. The Royal College of Psychiatrists recognises the importance of these years by monitoring the standard of posts and by examining trainees at the end of this period.

The current emphasis on improving the quality of dementia services is welcome, but it treats dementia as if it were separable from complex comorbidities, disability and frailty. As a consequence, dementia can overshadow other problems, from heart failure to multisystem failure at the end of life, which may be poorly managed. Three ways in which old age psychiatrists can reconnect dementia with the diseases and disorders of later life are described in this editorial. The first is to improve skills in general practice so that general practitioners (GPs) can take on the bulk of the clinical work of both diagnosis and management of dementia and its comorbidities, while specialists retain complex decision-making and management tasks. The second is for old age psychiatrists to function as consultants to social enterprises run by GPs for the purpose of managing almost all patients with dementia in general practice. The third is for community geriatricians and old age psychiatrists to work together in integrated organisations that take full clinical responsibility for older people with dementia.

The compulsory detention and treatment of patients against their will is unique to psychiatry. It is arguably the most stressful event in psychiatric practice, both for the doctor and for the patient, and yet, although much has been written about the details of mental health legislation (Clare, 1980; Fennell, 1995), very little has been said about the psychological impact that this procedure has on either the doctor or the patient (exceptions are Mills, 1962; Rogers et al, 1993). This paper will examine the emotional factors involved when a patient is deprived of his or her liberty, and will take as its point of reference the Scottish Mental Health Act.