The prevalence of moderate to profound learning disability is roughly 3 per 1000 and of mild learning disability about 3 per hundred (Abramowicz & Richardson, 1975). There are estimated to be more than 120 million people with learning disability worldwide.

The notion of brief dynamic psychotherapy (BDP) may seem at first sight to be a contradiction in terms. ‘Dynamic’ is a Freudian psychoanalytic term implying conflictual psychological forces — an opposition between the conscious and unconscious mind, and the use of defence mechanisms to arrive at a compromise between them. The rigidity of the obsessional person whose self-expression is traded for security, the self-reproaches of the depressive reflecting inhibited aggression, the clinging of the phobic individual who lacks an inner sense of a secure base — these would be examples of the relationship between dynamic conflict and psychiatric symptoms. But the image of psychoanalysis conjures up a picture of prolonged and intensive couch-based therapy. How can this be brief?

Jealousy has traditionally been treated by offering medication, support, or various forms of individual psychotherapy or counselling. However, jealousy is usually a condition which has a profound effect on the sexual partner of the jealous person, and they may actually suffer more from the condition than the person him/herself. While accepting that medication and other individual approaches have their place in the management of jealousy, there seem to be several advantages in seeing the problem from the standpoint of the couple relationship. Firstly, couple therapy reduces the almost inevitable labelling of the jealous person as a psychiatric case. Secondly, one might argue a priori that any changes which take place as a result of two people changing their behaviour are likely to be more stable and long-lasting than if just one person changes. There is another consideration, namely that, since the relationship is bound to be affected by the jealousy, it will need attention regardless of the means used to treat the jealousy itself.

During the last decade, direct work with children who have experienced public disaster or private catastrophe, such as abuse, neglect and other intrafamilial crime, has led to the recognition that classifications of post-traumatic stress disorder are relevant to childhood psychopathology. Comorbidity is common. Traumatised children who also are bereaved or dislocated are hindered in mourning and in the capacity to sustain or form attachments. Adult psychopathology often may be linked with unrecognised or underestimated effects of psychological trauma during childhood and adolescence. This paper discusses therapeutic interventions, outlines research hypotheses and provides an introductory bibliography.

The relationship between childbirth and serious mental illness has been known since the time of Ancient Greece. It was first described in the psychiatric literature by Esquirol and later by his pupil Marcé in 1857. A substantial number of women become mentally ill, often for the first time, following childbirth. There are few events associated with such a measurable and predictable risk to mental health as childbirth, with its nine months warning. Despite this, there is little awareness amongst general psychiatrists of the predictable and manageable risk that faces many of their female patients should they become pregnant, nor of the risks that mentally ill mothers may pose for their children.

Anxiety pervades every aspect of human activity and experience. It is a normal state and a spur to action, but readily exceeds normal limits in intensity, duration and appropriateness to the stimulus or situation. Anxiety is manifest by the mood of fearfulness, behaviour marked by restlessness and avoidance of situations, increased arousal with insomnia, excessive preoccupation with thoughts on the theme of insecurity, and a wide range of somatic symptoms which are based on muscular tension, hyperventilation leading to paraesthesiae and faintness, and symptoms based on overactivity of the autonomic nervous system. Excessive anxiety and situational avoidance leads to diminution of performance and limitation of endeavour. In the context of physical illness, anxiety increases the distress of symptoms, may confuse diagnostic procedure, prolong recovery time from acute illness, cause failure to comply with effective treatment and promote destructive habits such as reliance on alcohol or excessive use of sedative drugs.

Natural disasters occur infrequently in Europe, but the spate of transportation, crowd and other disasters in the late 1980s challenged our collective denial of potential catastrophe. Greater attention is now given also to the frequent small-scale traumatic events which are just as devastating to the many people affected by them, such as violent assaults and road accidents.

Liaison child and adolescent psychiatry has been described as the “partnership of child psychiatrists, paediatricians and other specialities concerned with children to provide integrated medical and psychological care for children” (Black et al, 1990). Although liaison work conjures up visions of the psychiatrist on the paediatric ward, it may also involve collaboration with community paediatric and primary care services. Indeed, the number of different professionals that may be involved with even quite mildly ill children is large (see Box 1). Much of the work is indirect (e.g. consultation with other professionals), but this and direct therapeutic work with children and families may continue long after discharge from the paediatric wards and clinics.

The 1988 US Surgeon General's Report entitled Nicotine Addiction reviewed the mass of evidence on the role of nicotine in tobacco consumption and came to three main conclusions, shown in Box 1.

The dopamine hypothesis for the mode of action of antipsychotic drugs has been with us for some 30 years and has, by and large, withstood the test of time. It simply states that antipsychotic drugs owe their therapeutic effects to an ability to block central dopamine receptors. This has given us a working and testable explanation for the effects of these drugs and it has prompted the synthesis of new agents. While so-called antipsychotic drugs (otherwise known as neuroleptics or major tranquillisers) are known to be effective in schizophrenia and related psychoses, mania, and the agitation associated with severe depressive illness or organic disorder, this paper is only concerned with the pharmacotherapy of schizophrenia.

Definitions for learning disability vary depending on the context in which they are used (Box 1), as does the terminology (Box 2). In the UK, the term ‘learning disability’ was adopted in 1991 by the Department of Health. The term ‘mental retardation’ is used in the ICD-10 (World Health Organization, 1992). Fryers (1991) has commented on the need for different definitions in order to distinguish the context in which the term is used.

Formal care plans extend the functions of traditional psychiatric case assessments by specifying more of the operational details of case management practice. They usually include descriptions of case management problems and objectives, the planned case management interventions, and who is involved in providing care.

Case registers have very little to do with computers or any other form of mechanical calculating machine. To write an article on case registers which concentrated on information technology would be as logical as an article on open heart surgery which confined itself to the finer points of scalpel technology. The creation of a case register is as simple or as complicated as the clinician wishes it to be; a case register at its purest is simply a list of contacts with patients, organised to a predetermined format, which allows the clinician to gain information from the list for education, research, planning or administration. The work needed to establish a case register, however, should not be underestimated, and the time spent in thinking through reasons for development of a register is a worthwhile investment. An understanding of the history of the development of psychiatric case registers may help those wishing to develop new registers to avoid treading well worn cul-de-sacs, while reviewing some of the work which has resulted from case registers may demonstrate the enormous potential of a well-designed register in facilitating the extension of knowledge about treatment and provision of services.

Mental health care is a complex undertaking. It involves care providers of many disciplines, administrative support staff, managers, funding bodies and of course carers and patients themselves. Each group has their own information needs; each, however, is primarily concerned with other things, and the importance of minimising the effort involved in amassing and accessing dependably accurate information cannot be stressed too highly.

The pharmacological treatment of the elderly differs from that of younger patients, mainly because of altered pharmacokinetics and the higher proportion of patients with organic disorders. We deal here with dementia, delirium, affective disorder, late-life schizophrenia, sleep disturbance, and rapid tranquillisation.