Although the definition of a specialist as an individual knowing “more and more” about “less and less” could be construed as a somewhat cynical critique of certain aspects of contemporary psychiatry, the Universal English Dictionary defines a specialist as a person engaged in a “special line of study or special branch of a profession”; a definition more relevant to this article which attempts to resolve the paradox of the “generalist as specialist”, and to outline the way in which general psychiatry is a special branch of a profession.

Greater care in the community will lead to the geographic dispersal of psychiatric services and the role of communications technology will become increasingly important. McLaren et al (1991) described the potential role for new communications technology, such as interactive television, in the provision of psychiatric services but before resorting to new communications technology it will be important to ensure that full use is being made of existing technology such as the telephone. The telephone is widely used in the UK health service but poorly understood, in contrast to the USA where it has been recognised as an important medium for care delivery (Hallam, 1989). This pilot study was designed to gather information on the current role of the telephone in an acute psychiatric service and to aid the planning of the use of more advanced communications technology such as interactive television.

Elderly patients constitute nearly two thirds of resident hospital patients (DHSS, 1988): 60,280 people were resident in mental illness beds at the end of 1986, and 34,340 were aged over 65 years; 21,500 had been resident for more than a year and 11,300 for more than five years. This represents a 15.7% fall in numbers of resident elderly patients over a decade, while numbers of younger resident patients fell by 40%. Mental hospitals are increasingly dominated by their population of elderly patients. Some patients have grown old in the hospitals, but more are admitted in late life and remain in care, usually because they are suffering from severe dementia.

This study considered the use of staff observation and patient's self-ratings of subjective psychopathology on admission to a psychiatric intensive care unit. The aim was to evaluate these measures as a means of predicting subsequent assaults and self-injury during the patients' stay on the ward. Few studies have shown a relationship between subjective experience and observable violent behaviour although some have found a correlation with ‘violence potential’. Eichelman & Hartwig (1990) have suggested the use of the SCL-90 hostility subscale, although doubts have been expressed about the ability of psychotic patients to complete such questionnaires reliably. The usefulness of both patients' self-ratings and staff observation would lie in their ability to help staff predict violence and self-injury and to take appropriate action.

A 44-year-old man was treated with amitriptyline by his general practitioner for ‘mild depression’. Shortly after starting treatment he was said to have become ‘beserk’; he hit his wife and a family friend with an iron bar and attempted to sever their heads with a kitchen knife. He was found guilty of manslaughter on the grounds of substantially diminished responsibility and sentenced to life imprisonment.

Research on day care has tended to focus on the day hospitals rather than day centres. A substantial body of work has evaluated the success of the day hospital as an alternative to the acute admission ward (Herz et al, 1971; Creed et al, 1989). But many day hospitals appear to have taken on long-term supports, the role envisaged for the day centres, as their principal function, rather than short-term treatment (Pryce, 1982; McGrath & Tantam, 1987): for example, Pryce draws attention to the accumulation of long-stay psychiatric day patients in a day hospital in South Glamorgan, where 67% of patients have been attending for between two and 17 years.

Since 1960, there has been a five yearly review of the population resident for more than three months at Glenside Hospital, Bristol (Cooper & Early, 1961; Early & Magnus, 1966; Early & Nicholas, 1971; 1977; 1981; Ford et al, 1987). These surveys have particularly focused on the accommodation and employment needs of the in-patients, but have also documented the nature of the changes that have occurred in the mental hospital over the last 30 years. The results of the seventh quinquennial survey are reported.

Following the recent reorganisation of the health service, doctors have been advised to accept the challenge of involving themselves in general management, (Ross, 1991), and the need for additional training in management skills has been recognised (Higgins, 1989; CTC Working Party Report, 1990). Local trainers, however, often do not know what sort of management training is appropriate, nor how or when it should be introduced into an eight year specialist training agenda, and the current situation for many trainees may, therefore, be described as hit or miss (Lock, 1991). Trainees need also to learn to consider not only their immediate clinical responsibility to individual patients, but also the broader concepts of preventive and public health medicine and the principles of equity, efficiency, quality and efficacy which underly the purchaser-provider contractual process.

As a senior registrar training in child and adolescent psychiatry I am preparing for an uncertain future. In addition to essential clinical and management skills, the ability to withstand stress and burnout seems crucial. I should like to write about my experience of working as a senior registrar at the Young People's Unit (YPU) Macclesfield which is a specialist adolescent unit under chronic threat of closure.

The co-ordination of services for the long-term mentally ill in the community poses difficulties of organisation. Each country has its own health and social service structure which influences the development of such services. This paper outlines an approach to co-ordinating care in Portsmouth. The mental health services were well known in the ‘30s because of their community orientation due to the leadership of Thomas Beaton, the superintendent of St James' Hospital (Freeman, 1962). The city has a population of 210,000. Previous seaside holiday accommodation is now utilised for residential care homes for the elderly and the mentally ill.

Australia is a unique, geologically ancient island continent. Its flora and fauna are unlike those found anywhere else and the same may be said of its people, politics and health services. The population of 17.3 millions represents a multicultural mix, with an anglo-celtic core conflated by sustained post-war immigration from southern Europe, Turkey, southeast Asia and south America. One in five current Australians was born elsewhere, one in ten comes from a non-English speaking background, and a quarter of those born here have a parent who was born overseas. Aboriginals and Torres Strait Islanders form 1.4% of the total population. They have third world mortality figures but die of first world diseases, their life expectancy being 20 years less than that of other Australians. Two hundred and four years after what they see as the British invasion, their standard of living lags far behind all other socio-cultural groups in the country. Most members of the Aboriginal community do not live long enough to develop Alzheimer's disease, but it and other age-related diseases are emerging as the major determinants of health costs as Australia moves towards the 21st century.

Imagine an “intelligent” sheet of paper, on which you could record data in an organised fashion, and format its appearance for publishing purposes, but which could also do it's own calculations, (with the answer appearing automatically), and draw graphs of the results. This is essentially what a spreadsheet does.

The first meeting of the Violence Management Special Interest Group on 25 February 1992 drew a mixed group of delegates from three of the 15 Scottish Health Boards, three Regional Social Work Departments and several Education Departments, as well as the Scottish Prison Service. The majority of those who attended were actively engaged in designing training programmes for public sector staff.

The conditions endured by mentally disordered defendants remanded in custody have been the subject of mounting concern in England. The Home Office has issued guidelines which encourage the diversion of the mentally disordered from the criminal justice system whenever possible. In an attempt to reduce the number of custodial medical remands, new schemes have been set up which target the magistrates' court, instead of the remand prison, as the site for psychiatric assessment (Joseph & Potter, 1990; James & Hamilton, 1991). These schemes are in their infancy and currently suffer from a lack of funding and have yet to find general acceptance from hospital based psychiatric services.

A group of interested people met for two days last year in order to attempt to reach a consensus on good practice in the management of patients with generalised anxiety. The result of their efforts is published below.

Most patients presenting with anxiety, whether acute or chronic, mild or severe, were until recently treated with tranquillisers. Recognition that these drugs can cause dependence in some patients has prompted a re-evaluation of the pharmacological management of anxiety and the value of non-pharmacological treatments is now recognised. Uncertainty remains among many doctors about the efficacy of the whole range of current therapies and the place of the new classes of drugs for anxiety. However, research findings are now accruing which indicate the relative merits of these various therapies, and clarify the principles on which they are based.