A postal survey of the drug treatment of behavioural emergencies by senior registrars and consultants in psychiatry revealed that 90% would initially use a non-depot antipsychotic (including 24% who would combine it with a benzodiazepine if the situation warranted), and 10% the short-acting depot, zuclopenthixol acetate, with another antipsychotic or a benzodiazepine, or both. The choice was made from a restricted range of drugs, with haloperidol being the most popular antipsychotic and diazepam the most popular benzodiazepine. Half of respondents did not consider British National Formulary maximum dose recommendations to be useful for rapid tranquillisation and many would exceed them. A substantial minority did not consider that adequate resuscitation was available at their unit and deficiencies were revealed in the training of junior doctors and in the audit of rapid tranquillisation. Very few psychiatrists reported that their units had written guidelines.

In October 1982 Council discussed a paper by me with the above title in which I posed a number of questions. The document was then widely debated within the College, and on the basis of responses received I presented a report to Council in October 1983. Council endorsed a number of recommendations and these are now embodied in this paper.

Shame is a highly prevalent, though rarely discussed, emotion experienced by trainee doctors. Seeking to avoid the pain of shame can cause significant distress and maladaptive behaviours. However, it plays a key role in helping doctors identify their moral values which, in turn, form the basis of their medical professional identity. This article uses personal doctors’ narratives together with sources from sociology, psychology and medical education to address shame as experienced by medical trainees – its causes, effects and remedies that doctors and medical educators can use to neutralise its malign effects.

The Royal College of Psychiatrists specifies that supervision of trainees is the single most important ingredient of training. This paper reports the results of a pre-audit survey about trainee supervision. Eighty-three per cent of consultants (n=52) and 67% of trainees (n=51) responded to a 21-item Likert questionnaire. There was unanimous agreement for seven items. A significant number of consultants and trainees were dissatisfied with the existing arrangements despite the majority being involved in weekly supervision. The minimum standards proposed served as the basis for providing guidelines against which practice may be audited.

Why has liaison psychiatry been slow to develop in the UK? The asylum mentality and the current flight into the community have focused psychiatric resources on chronic psychotic illnesses, neglecting the psychological problems of general hospital patients. Nevertheless, there is abundant evidence that medical and surgical patients have a high prevalence of psychiatric disorder that can be effectively treated with psychological or pharmacological methods.

A retrospective case note study explored readmissions to an acute psychiatric in-patient unit within six months of discharge. The study aimed to calculate a hospital readmission rate, to investigate the timing of readmissions, and to identify risk factors associated with readmission. The readmission rate was 27% with the majority of readmissions occurring within three months after discharge, suggesting the need for investigation of such early readmissions. The three factors found to predict readmission were: discharge against medical advice, number of previous admissions, and living alone or with family rather than in care. Implications for hospital service planning are considered.

Ukraine, a nation of 48 million, became independent in 1991 following the collapse of the USSR. Ukraine still lags far behind many European countries in absolute income per capita and indices of transparency and corruption in public life, but its economy, grounded on robust industrial and agricultural resources, has grown 10% annually in the past 4 years. The extraordinary developments associated with the 2004 presidential elections and the Orange Revolution mean that democracy is now at the core of the state-building process and that Ukrainians are ready for radical changes. These changes are bound to include the principles and methods that have long prevailed in Ukrainian psychiatry.

As I walked into the waiting room, I remember being struck by his appearance. Although he was almost exactly my age, I saw an old, tired-looking, white-haired man, his face deeply lined and drawn. I wondered what I had to offer this survivor of torture. Would I be able to help him recover from such a dreadful trauma? How could anyone come to terms with an experience which seemed to threaten some of the most basic human needs?

Numerous commentators have noted a historic ambivalence between religion and psychiatry. However, a growing body of evidence indicates an association between mental health and various religious activities, both private and public. As such, there are growing calls for greater religious sensitivity among mental health clinicians, to help unlock the potentially healing aspects of religiosity. So far, most literature from English-speaking countries has focused on Christianity and mental health, with little attention paid to Muslim mental health. This is the fastest growing religion in English-speaking countries, and the mental health of Muslims in these countries is under-researched. As such, the present paper summarises new directions in the mental health and religion literature, with a focus on the mental health of Muslims in English-speaking countries.

Considerable research has been conducted on particular approaches to the psychotherapy of post-traumatic stress disorder (PTSD). However, the evidence indicates that modalities tested in randomised controlled trials (RCTs) are far from 100% applicable and effective and the RCT model itself is inadequate for evaluating treatments of conditions with complex presentations and frequently multiple comorbidities. Evidence at levels 2 and 3 cannot be ignored. Expert-led interventions consistent with the emerging understanding of affective neuroscience are needed and not the unthinking application of a dominant therapeutic paradigm with evidence for PTSD but not complex PTSD. The over-optimistic claims for the effectiveness of cognitive–behavioural therapy (CBT) and misrepresentation of other approaches do not best serve a group of patients greatly in need of help; excluding individuals with such disorders as untreatable or treatment-resistant when viable alternatives exist is not acceptable.

A survey was undertaken to establish the current state of liaison psychiatry in England, Scotland and Wales. Eighty-six consultants were identified who carry out specific work in liaison psychiatry, 43 of these consultants hold either full-time or half-time posts in liaison. Sixteen new posts in liaison (full-time equivalent (FTE) or half-time equivalent (HTE)) have been created in the past two years. Half of these were entirely new posts and half have been created by consultants already in a general psychiatry post renegotiating their contracts. Some specialist registrar schemes have no training slots in liaison psychiatry and others have training slots in liaison psychiatry which are supervised by a trainer who is not in a FTE/HTE liaison post. A national database is required to track expansion in liaison psychiatry and training at specialist registrar level needs to be developed.

This study investigated the knowledge and attitude of 100 patients about their depot neuroleptic medication. Patients were well informed about their medication, particularly those seen in depot clinics. Most patients were content with service delivery but 48% did not realise that they had a choice about receiving their treatment. This aspect of patients' rights should be addressed and demands sensitive management in the case of depot refusers, or when assertive outreach is planned. We suggest that such issues should be incorporated into an educational programme and discussed with patients when they are relatively well.

Psychiatry in Uganda has a fine pedigree. Academic psychiatry was established in the late 1960s when the Makerere University Department of Psychiatry was founded. Academic medicine and psychiatry suffered during the Amin regime but, like the country as a whole, these have begun to rebuild themselves over the past 10 years. Problems still remain including poor facilities, lack of resources, and a need to revise the Mental Treatment Act and standards of treatment. The high prevalence of AIDS and post-traumatic stress disorder place added burdens on Ugandan psychiatry.