Childbearing, from the standpoint of psychological medicine, is the most complex event in human experience (Brockington, 1996). Pregnancy and childbirth involve major biological, social and emotional transitions and expose the mother to a range of psychological and medical complications. There are about 20 psychiatric disorders occurring in the post-partum period (see Table 1).

The management of patients with depression who have failed to respond to antidepressant medication is a common problem in general and old age psychiatry. It has been estimated that about 20–30% of patients with major depression fail to respond to treatment with a single antidepressant drug given in adequate dosage for an appropriate period of time. At the current time there are many possible ways to pursue pharmacological treatment, but few controlled trials to help us choose between the various options. In addition there are few clinical predictors to help match patients to an appropriate treatment.

Competence should be “at the heart” of medical practice to ensure patient confidence in health care (Calman, 1996), but what is competence in relation to medical practice?

There can be few more agonising experiences than being falsely accused of having sexually abused one's child – except perhaps to be told that one's long-standing memories of childhood abuse are an example of false memory syndrome. People have been profoundly hurt both by false accusations of abuse and by false denials and dismissals of memories of abuse. Both of these can happen.

In my view Dr Mollon fails to achieve the balance he is seeking and at times appears to take a partisan position.

The term ‘epilepsy’ refers to a tendency to have recurrent seizures. Epileptic seizures arise from an imbalance of excitatory and inhibitory cerebral neurotransmitters associated with sudden, paroxysmal, synchronous and repetitive discharges of neurones. All normal brains have the capability to have seizures. Epileptic seizures arise where there is lowering of the naturally occurring seizure threshold. Excitotoxins such as glutamate released in the brain during seizures can cause irreversible cell damage. Young children are especially vulnerable. Prolonged seizures (greater than 30 minutes) in children correlate with subsequent learning disability.

Gender dysphoric disorders are currently attracting a great amount of attention. Generally, this attention is appropriately scientific and not condemnatory. This is possibly because of changing attitudes, but also because of the dissemination of information about what may be done to help people with these disorders. People are coming forward to request such help. Whether the surge of applicants to gender identity clinics (GICs) is due entirely to the change in attitude or whether there is a true increase in incidence of these disorders is at present undetermined. The fact, however, remains that prior to the second half of the present century little professional attention was paid to gender dysphoria (Bullogh, 1975).

Dementia with cortical Lewy bodies (LBD) was first described by Okazaki et al in 1961 and is now recognised as a relatively common cause of the dementia syndrome. The true prevalence of LBD is unknown. In post-mortem studies of patients diagnosed as having dementia in life, the mean frequency of Lewy body dementia is 12.5% (Byrne, 1997). Clinically diagnosed LBD (using operational clinical criteria) is found in 10–23% of patients presenting to, or in the care of, psychogeriatric services (Collerton et al, 1996). What is not yet certain is its nosological status; opinion is divided between regarding it as a variety of Alzheimer's disease (the Lewy body variant), a distinct disease (senile dementia of the Lewy body type) or a spectrum disorder related to both Parkinson's disease and to Alzheimer's disease (Byrne, 1992).

The article by Byrne gives a general overview of dementia with Lewy bodies (LBD) and discusses treatment in terms of modulation of neurotransmitter systems, treatment of psychotic symptoms and extrapyramidal features. However, as is the case with Alzheimer's disease, the dementia is related to underlying pathological processes which result in death and/or malfunction of neurons. Prevention or amelioration of this neuronal loss is therefore the ultimate aim of treatment. Such treatment is not yet available and the possibility of its development is likely to depend on further elucidation of the underlying pathological process. The relationship of LBD to Alzheimer's disease and Parkinson's disease should be considered, as this is important for the determination of the underlying pathological processes in LBD.

Byrne provides an excellent clinical overview. However, I have selected four areas of clinical interest for more detailed consideration.