We describe our experience of running a group using active therapy techniques for adults with a teaming disability, and briefly explore cognitive developmental theory in an attempt to understand some of our observations.

In this article we describe a six-month attachment to the Mental Welfare Commission for Scotland undertaken as part of higher professional training. We discuss the training benefits of such an attachment, emphasising the valuable overview it provided of mental health policy and the use of guardianship and leave of absence.

A previous survey (Gravestock, 1996) assessed factors associated with depot neuroleptic usage in 79 adults with learning disabilities using mainly community-based services. The data informed consensus standard setting and this audit focusing on 32 out of 79 original subjects. At two year follow-up, five subjects had been withdrawn from depots; there was a significant (P < 0.001) reduction in subjects' median depot dosage and reduced concomitant usage of oral neuroleptics and anticholinergics. The importance of completing the audit cycle and other psychotropic medication monitoring studies in community learning disabilities services are discussed.

Previous articles have dealt with aspects of training in Canada (Green, 1985), and in particular arrangements that exist for UK trainees to undertake a year's experience in Nova Scotia (Munro et al 1987). In addition, there have been accounts of trainees' experiences in particular settings (Ferguson, 1989; Gojo, 1992). Procedures required to enter Canada to practise psychiatry are complex and involve general and specialist medical registration (licensure to practise and certification as a specialist), remuneration and immigration procedures. This article is an introductory guide and highlights recent changes in registration and postgraduate training.

Over the last 20 years the Spanish system for postgraduate education has been channelled, for all specialities including psychiatry, through the MIR Exam (Medico Interno Residente). This is an exam that all Licenciates in medicine and surgery (the Spanish equivalent for the British MBBS degree) can take after finishing their medical school training.

A survey of consultant psychiatrists identified the core characteristics of patients who require referral for specialist dynamic psychotherapy. Those are patients with neuroses, personality disorders and affective disorders who have longstanding and complex emotional and interpersonal problems which stem from their early life experiences. They need a level of expertise and an intensity and/or length of treatment which cannot safely and reliably be provided by either general psychiatric services or primary care. The survey suggests that 0.1% of the population/year would benefit from referral for specialist dynamic psychotherapy.

A survey of a group of doctors and nurses specialising in the care of the elderly demonstrated a wide range of opinions on the usefulness of major tranquillisers for controlling behavioural disturbance in dementia. However, there was ‘broad agreement’ among medical and nursing respondents that these drugs were unlikely to be helpful in controlling non-violent resistiveness and sexual inappropriateness. The nurses indicated less ‘forth’ in neuroleptic therapy than their medical counterparts. The importance of auditing the use of major tranquillisers in dementia is emphasised.

Service usage of 24 patients with a personality disorder was established for one year pre-treatment and one year post-treatment via a prospective survey of the patients, their original referrer and their general practitioner. The average annual cost of psychiatric and prison services (calculated from extra-contractual referrals (ECR) tariffs and Home Office data) was £13 966 pre-treatment compared to £1306 post-treatment, representing a cost-offset of £12 658 per patient per year. The average cost of the specialist admission was £25 641. Thus the cost to the Nation for treating these personality disordered patients in a tertiary treatment resource would be recouped within two years and represent a saving thereafter.

In contrast to other professional groups, psychiatrists currently receive little formal training in the use of the Mental Health Act (MHA). This article describes a locally organised training day for senior registrars and reports on their previous experiences and future training needs in the use of the MHA.

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.

We performed a survey to examine the behavioural–cognitive psychotherapy teaching and experience of trainee psychiatrists in the South Thames (West) Region. Sixty-four per cent of the whole sample who responded to the survey, including 90% of the registrars who responded, had treated at least one patient using behavioural cognitive methods. Few trainees reported no experience of behavioural cognitive psychotherapy with almost all attending some form of teaching. Trainees generally reported that they valued this experience.

The Internet opens up brand new possibilities for medicine. Nowhere before has it been possible to confer with colleagues from all over the world to swap ideas on an hour-to-hour basis on all manner of subjects.

Why do children always know when we want them to behave beautifully and do the opposite? No doubt Lady Cockburn thought it a delightful idea to pose as Cornelia with her children in the classical style so fashionable in 1773. Sir Joshua Reynolds has caught a moment of formal harmony just before it dissolves into all too human chaos. Who can doubt that at any second George, the imp on the right of the picture, will tighten that chubby clasp into a strangle-hold and pull down the temptingly loose coils of mother's hair? James, the child on the left, will not be slow to join in and baby William will howl as he is trampled on by his lively brothers. One small boy on his own is (sometimes) manageable; three together in any century spell trouble for grown-ups! Their mother already has a faintly strained look behind her lofty pose. She is distancing herself from the situation by fixing her eyes on the middle distance in a way well known to those who have discovered from experience that pleas, bribes, prayers and even threats cannot prevail against the exuberant life in a group of children. Will she eventually give way with good humour and indulge in a romp, or will it be smacks and tears all round and nursemaids summoned to remove the guilty parties, roaring, back to the nursery? She looks quite young in spite of the stuffy pose so who knows which way it will go. We tend to assume that youngsters in the old days were always brought up with harsh discipline. Of course life was hard and brutal for everyone and child abuse common, but many parents have also loved, petted and delighted in their children throughout the ages. The stem puritanical manuals that grate on us so much – “You must break a child's will by the age of five”, “Spare the rod and spoil the child”, “Rule by fear” – were written by disapproving experts to counteract what were seen as lax tendencies to over-fondness and spoiling of children.

The common thyroid disorders are all autoimmune in origin, with the lifetime risk of thyroid disease being 1–2%. Thyroid autoantibodies are present in 9% of the adult population and 12.7% of women, with the frequency rising steeply in women over 45 years of age (Myers & West, 1987). In addition, 20% of the over 60–year-olds have an abnormal (raised) thyroid stimulating hormone (TSH). The presence of both raised TSH and thyroid autoantibodies is associated with the development of clinical hypothyroidism at the rate of 5% per year (Myers & West, 1987).

The police are increasingly requesting assesments of detainees' fitness to be interviewed. Senior registrars in psychiatry are often asked to perform this task. Gudjonsson has derived a set of guidelines from a Judge's ruling following a recent court case. Our survey identifies that the current practice of a group of senior registrars in psychiatry falls short of these guidelines. Reasons for this and implications for training are discussed.

Evidence-based medicine is an approach to clinical training and practice that is increasing in popularity. When introduced into the journal club format, it provides an opportunity to integrate real clinical problems with critical evaluation of the psychiatric research literature. The principles of evidence-based medicine and the practicalities of its introduction into the Journal club format are described.

Most doctors are probably uncomfortably aware of the old joke that an alcoholic is someone who drinks more than his doctor. But how would one define a drug addict? Because of the taboo and illegal nature of drug misuse, if a similar doctor-based definition were coined, even in jest, it would cause a degree of consternation and indignation among the profession. However, the evidence that doctors abuse certain substances, in particular opiates and tranquillisers (Hughes et al, 1992), more commonly than the general population is well established.

The APA is concerned about its declining membership. Only 16 700 psychiatrists were able to attend this year's meeting in New York and many of them came mainly to consult the job bureau in search of employment. For the first time unemployment is a real issue for psychiatrists as health care providers restrict services and seek alternative and cheaper patterns of care. Most health care organisations have lists of approved psychiatrists and anyone not on that list is not able to claim reimbursement for their services. Exclusion may be because of unreported and unchallenged complaints about care or conduct or a penchant for expensive drugs or high risk therapies. In this context a high risk therapy is one which exposes the insurers to a high risk of litigation, such as ‘recovered memory therapy’. The buzz in the corridors, which used to be of art collections, the new home by the lake or the costs of putting the kids through college, is now of managed care. These dread words reduce the most ebullient colleagues to anger or tears. Some time ago I reported in amazement the discussions at an earlier meeting on alien abduction, ritual abuse, multiple personality disorder (110 different individuals in one body was then the record) and the false memory syndrome.

General practitioners (GPs) were surveyed by questionnaire to determine their views on the indications for specialist psychotherapy and their estimates about the number of patients they thought should be referred. GPs had good awareness of the types of treatments available. There was close agreement between referring and non-referring GPs and with specialists on the indications for treatment. Estimates about demand for services showed that those who had not referred in the previous year estimated higher rates than those who had referred. GPs and specialists show good overall agreement on level of service and the indications for its use.