For some years, the pace of progress in clinical neuroscience has progressively quickened but none more so than with molecular biological techniques. Clinical psychiatrists have been promised (some say forewarned) that the systematic application of these techniques will swiftly cut through the multifactorial aetiologies of many mental illnesses and revolutionise diagnosis, treatment and, possibly prevention. Not surprisingly, given the fact that Down's syndrome and Alzheimer's neuropathological changes (senile plaques and neurofibrillary tangles) are so tightly linked, understanding of Alzheimer's disease (AD) was the first mental illness to benefit from these new methods. Once the amyloid β protein component of the senile plaque had been isolated and its 39–43 constituent amino acids sequenced, then it became almost a routine matter to locate the gene and describe comprehensively the much larger (approximately 710 amino acids) amyloid β protein precursor (APP). Almost simultaneously, the gene responsible for familial pre-senile Alzheimer's disease (FAD) was located, like the APP gene, on chromosome 21 (Tanzi et al, 1989). Soon, a claim was made that these (FAD and APP) were the same gene, and, in a manner akin to the presumed causal gene dosage effects in Down's syndrome, Alzheimer's disease was attributed to excess production of amyloid (by way of APP). However, this was quickly refuted and data to support a gene dosage effect in AD were not confirmed. The trail then seemed to go cold. Several studies indicated that FAD was genetically heterogeneous and distinct from senile AD (St George-Hyslop et al, 1990), and the problems of prion disease in animals and man secured more attention (Westaway et al, 1989).

The Marcé Society, a multidisciplinary group set up in 1980 to advance the understanding, prevention and treatment of post-partum mental illness, met in York for its biennial meeting last September to celebrate its tenth birthday. In the middle of the 19th century, Louis Marcé first drew attention to the special nature of psychiatric illness in the puerperium. Since then, as opening speaker, Dr Channi Kumar pointed out, although maternal morbidity has dropped dramatically, in particular over the last 40 years with improvements in obstetric care together with social, cultural and educational changes, psychiatric morbidity in the puerperium remains as prevalent as it was 100 years ago.

The Academic Sub-Department of Psychological Medicine in North Wales was opened on 19 October 1990 by Professor Andrew Sims, President, The Royal College of Psychiatrists.

There has been considerable interest in doctors' interviewing skills during the last few decades (Nuffield Working Party, 1978). Despite this interest, there has been no consensus as to how these skills may be taught to medical students. We describe the ongoing evolution of a teaching package for these skills as taught by the Liverpool University Department of Psychiatry.

This comment by Diana Brahams, Barrister at Law, is the latest on automatism in her regular series in The Lancet on the Law as it affects medicine. It is a subject to which she has had occasion to return frequently (Brahams, 1983a, 1983b, 1989) as several recent cases have developed the legal concept of automatism to the increasing confusion of many psychiatrists. Automatism has also been thoroughly discussed in a recent monograph in Psychological Medicine by Peter Fenwick (1990) which is to be recommended to anyone having to prepare a report dealing with this problem.

In discussions of the psychopathology of the double, acknowledgement is usually given to the various literary accounts of the subject by Dostoevsky, De Maupassant and Stevenson (Christodoulou, 1986). Curiously, mention is never made of the work that has been described by Karl Miller (1985) as “the cardinal text” in the literature of the double. James Hogg's The Private Memoirs and Confessions of a Justified Sinner, published in 1824 and since recognised as a Scottish literary classic, represents the most detailed and complex exploration of the theme of the double.

Managerial and administrative personnel are increasingly to be seen using desk-top computers. With medical staff, however, it seems to be commoner to find their computers sitting at home. This is likely to be because clinicians are essentially mobile in their working, and although the career structure dictates that publications are essential, there is no time-slot during the clinical day for such activity.

With the closure of large mental hospitals there is increasing emphasis on community psychiatry (Thornicroft & Bebbington, 1989) and a need for experience and training at all grades in this speciality. Some training aspects of an area of community psychiatry as experienced by a senior registrar are detailed.

By 1841, advances in communication and education, coupled with an increasing number of medical staff attached to mental asylums, made the idea of a formal grouping of such asylum staff a viable proposition. Although, as the following paragraphs indicate, such a group took many years to become established, the body whose early years are described briefly here, is the direct ancestor of the Royal College of Psychiatrists.

It is hard to believe that this coming together of the Royal Colleges of Physicians and Psychiatrists to discuss the patients that so often bounce back and forth between the specialists was the first of its kind.

Entries in the minute books of the New Bethlem Hospital Building Committee from 1813–1816 contain details of the commissioning, installation and subsequent extensive modification of a system for heating the hospital. The system adopted was chosen principally for its cheapness, but in a manner that may seem familiar in the current climate of competitive tendering, with adoption of the cheapest proposal; through the incompetence of its manufacturer it was to prove problematic and dangerous.

William Cullen (1710–1790) was the greatest teacher of clinical medicine in Britain in the 18th century. He was born in Hamilton in Lanarkshire and began his career in Glasgow where he held the chair of chemistry and was one of the founders of the medical school. In 1755 he moved to Edinburgh with its already flourishing medical school and its new hospital, the Royal Infirmary, and there he held in succession the chairs of chemistry, the institutes (theory) of medicine and the practice of physic. Together with Alexander Monroe he made Edinburgh the most famous medical school in the Western world and students came from far and wide to be taught by him – from England, Scotland and Ireland, from the Americas and the West Indies and from the Continent. Like Boerhaave, his reputation rested mainly on his gifts as a teacher and it is clear that his students idolised him. Benjamin Rush, the founder of the first medical school in the New World in Philadelphia, America's first psychiatrist and one of the signatories of the American Declaration of Independence, wrote of him that “It is scarcely possible to do justice to this great man's Character either as a scholar, a physician, or a Man”.

Becoming demented is something people dread most about growing old; the image of a confused and wandering elderly person is a powerful and distressing one. Alzheimer's disease is the commonest cause of dementia, affecting 500,000 people in Britain alone. It is a progressive and presently incurable brain disease, causing great suffering and imposing an enormous burden on health resources. As a result, a large research effort is under way to find out what causes the disease, since a cure is only likely to emerge once the disease is understood. This research is wide-ranging and diverse, as the complexity of Alzheimer's disease requires many lines of enquiry if the puzzle is to be solved. At one extreme, the research focus is upon large groups of elderly people who are being followed up to see what features predict and herald the onset of dementia. At the other, individual genes, molecules and brain cells are under detailed investigation. Some of the latter studies have given important clues as to the cause of Alzheimer's disease, and these are briefly mentioned here.

Mark Jones continues this occasional series by taking a look inside Wagner's tetralogy The Ring of the Nibelung which was first performed complete in 1876 at Wagner's own opera house in Bayreuth.

Apart from the degree of mental handicap, the traditional description of a genetic syndrome is limited to somatic characteristics, although occasionally noting some quirk of personality or behaviour. However, these subjective stereotypes become a memorable part of our concept of the syndrome. Although at times startlingly perceptive, more often they are misleading, particularly where there has been only a superficial contact. Latterly more systematic scrutiny, albeit using idiosyncratic rating scales, selected populations, and differing diagnostic standards, has highlighted earlier inadequacies. Consequently the last three years have seen the formation of an informal, multidisciplinary group interested in behavioural phenotypes: an initiative greatly helped by contact with parent groups. Their intention is to develop research and, by introducing some consistency to the observations, to allow comparisons across studies. From this has grown the more public and formal Society for the Study of Behavioural Phenotypes† which was launched at this symposium.

There is a serious flaw in much current thinking about the development of ‘community’ psychiatry because of the failure to consider the function of admission wards and to resource them adequately. Excessive emphasis is placed on the value of non-hospital psychiatry with an implication that psychiatrists can manage patients adequately without beds (see Dean & Gadd, 1990). Although I have not met a consultant who literally believes this to be true, the managerial consequences of this attitude leads to in-patient units being yet further under-resourced, and so becoming more disturbed and having lowered morale. Yet in Better Services for the Mentally Ill (HMSO, 1975) the District General Hospital In-patient Unit was regarded as a main component of a comprehensive psychiatric service. Clinical experience does suggest that without an effective admission ward the management of patients in the community, including those with intractable mental illness, is unsatisfactory and sometimes totally impossible.

In 1987, 38% of Royal Free medical students answered the question “How could the child psychiatry course be improved?” by asking for “more”-in particular, they wanted more “hands on” experience.

The Edith Morgan Centre is a 60-bedded acute psychiatric in-patient unit on a DGH site, now open for three and a half years, following the closure of a nearby psychiatric hospital.

Scottish Action on Dementia had its origins in informal meetings of individuals drawn from a variety of health care professions with a shared concern about the inadequacies of provision for dementia sufferers in Scotland in the mid 1980s. At the heart of these concerns lay the absence of any effective response to two major documents – the Timbury Report and SHAPE (Scottish Hospital Authorities Plans for the Eighties). Both accorded the highest priority to care of the elderly, particularly those suffering from mental illness, and had been accepted by all the principal parties concerned as the blueprint for health care policies in Scotland in the 1980s. The sober realities of 1985 prompted the founding members of Scottish Action on Dementia (SAD) to set themselves up as a multidisciplinary forum with three principal functions – to promote public education and awareness of dementia and its implications for sufferers, families and society at large; to act as an independent pressure group; and to monitor activities in the field of dementia care with a view to promoting and maintaining high standards. Five years later these objectives remain unchanged.