The aim of medical audit is to improve the quality of medical care (Department of Health, 1989). There was concern that patients referred to a psychogeriatric service (Service X) did not have adequate access to computerised tomography. The nearest computerised tomography scanner was located in a neighbouring district and direct referrals were not accepted. Computerised tomography scans could be obtained indirectly by referral to neurosurgeons. Because of these difficulties “potentially treatable structural lesions” (such as cerebral tumours and subdural haematomas) may have been missed. We decided to compare the use of computerised tomography scans with a nearby service (Service Y) which had a computerised tomography scanner on site. Service X had a catchment population of 33,000 aged over 65 and Service Y a catchment population of 23,420 aged over 65.

Over the years the ‘depot clinic’ has become little more than a conveyor belt for patients to receive depot medication from nursing staff within a hospital setting. Indeed, the concept of the depot clinic has not significantly changed since the introduction of neuroleptic medication in the 1950s. A lack of review of the service has resulted in suboptimal treatment, unchecked side-effects and a lack of monitoring of physical health. We describe the redesign of a depot service within an inner city community service, with emphasis on evidence-based practice, regular, patient-centred reviews, support, health promotion and education.

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.

There is increasing concern, both among doctors and the lay public, on the potential for dependence of the benzodiazepine group of drugs. In order that the Royal College of Psychiatrists could publish a view on this contentious topic, a consensus meeting was arranged on 10 June 1987 by the Programmes and Meetings Committee (see list of participants). The following statement has now been approved by the College.

By the 1970s three groups of psychiatric patients were receiving a particularly poor deal from the National Health Service: (a) The psychopathic patients who had never received the special facilities recommended by the DHSS; (b) A new group of patients, i.e. the difficult or dangerous psychotic patients who are now being refused admission to local hospitals, but whose behaviour is not such as to require the care of a Special Hospital; (c) The difficult or dangerous subnormal patients who could not be managed in new style or overcrowded, understaffed subnormality hospitals.

The 1983 Mental Health Act made a requirement under Section 58 for a second opinion by an Appointed Doctor when a detained patient either did not understand the nature, purpose, and likely effects of a treatment or did not consent. The present study is confined to second opinions relating to ECT (electric convulsion therapy) and extended medication. It was noted in the Mental Health Act Commission's Biennial report that requests for second opinions varied in numbers between different hospitals and psychiatric units. In 200 personal visits by the author a Treatment Plan by the Responsible Medical Officer (RMO), which is an indication of good practice in the operation of the Act, was written in the case notes in only 66 cases (33%) and then most often by a junior doctor. This finding has been reported generally. It seemed appropriate, therefore, to explore the opinions of Consultant Psychiatrists on the legal requirement for second opinion.

Last year I was fortunate enough to visit two GP friends running a district hospital in northern Malawi. As I had just taken Part 1 of the Membership Examination, they were intrigued to know my professional view of a condition called ‘the vimbusa’. In their experience, the vimbusa was a common complaint with a wide variety of presentations, none of which corresponded with disease entities they had learnt during their training. After a fascinating two weeks I was unable to categorise the vimbusa according to ICD-9, but the following essay summarises my attempts to understand this condition.

Large mental hospitals are gradually being emptied. Patients return to the community. But often their prospective carers have little idea of what to expect when they arrive. Hospital staff often cannot give information regarding how disturbed patients might be.

(1) Authors may be divided into three classes – shooting stars, planets, and fixed stars. Arthur Schopenhauer: Parerga und Paralipomena, 1851 How brightly should you shine, and for how long? At appointments committees lists of publications are becoming increasingly important as proxy measures of candidates' abilities and potential. As competition for posts becomes fiercer, number and quality of publications are likely to assume even greater importance when similarly qualified individuals are being compared. We may bemoan this trend but in the absence of other more valid indicators of worth and from the point of view of self-interest it would be prudent to acknowledge it and to support it.

Assaults against healthcare staff have gained increasing attention, prompting the Zero Tolerance Zone campaign in the National Health Service (NHS) (Department of Health, 1999). This advised that treatment could be withheld as a sanction, although not from ‘anyone who is mentally ill or under the influence of drugs'. More recently the NHS Security Management Service (Department of Health, 2005) found that the greatest number of assaults (over 43 000) were found in mental health and learning disability environments.

The Job descriptions for five consecutively advertised consultant posts in psychiatry of old age were surveyed for the content and clarity of the information provided and for the adequacy of the resources described. Only one post provided a job description which came close to meeting our audit criteria. Employers may optimise the number and quality of applicants for consultant posts in psychiatry of old age by providing Job descriptions which contain both clearly written and comprehensively detailed information.