Agomelatine is a new antidepressant, licensed for the treatment of unipolar major depression, with a mode of action that combines activation of melatonin receptors with blockade of 5-HT2C receptors. Agomelatine is notable for its short duration of action in the body and modest side-effect burden; however, a number of theoretical and practical challenges have limited its adoption into mainstream treatment in the UK. Current meta-analyses show marginal clinical benefits of agomelatine relative to placebo and an association with occasional increases in liver transaminases. Theoretically it is not clear whether agomelatine does block brain 5-HT2C receptors in humans at therapeutic doses and the optimum daily timing of administration in depression has not been clearly established. However, agomelatine's novel mode of action justifies further study, perhaps with the eventual aim of matching its use in depression to patients with specific disturbances in circadian rhythm.

User centred services as an ideology have not become a reality of everyday clinical practice. In this paper we introduce a series of articles which describe user centred practice in a south London community-based rehabilitation service for the severely mentally ill. We emphasise the medical consultation style adopted, the service management style and specific initiatives allowing users to influence our practice and shape functional and structural components of the service.

The term Afro-Caribbean is used to describe black people of Caribbean origin in Britain. Migrants from the Caribbean, their children and their children's children are all covered by this term. The group as a whole is reported to have a higher incidence rate of schizophrenia than white groups, (King et al 1994), and British-born children of Caribbean parents have an even higher rate (Harrison et al, 1988). These reports have led to the hypothesis that Afro-Caribbeans may have a special vulnerability to schizophrenia. While limitations to these studies have been identified, (Wessly et al 1991) none has sought to question the use of the term Afro-Caribbean as a valid and reliable ethnic grouping. If we are to be able to produce good hypotheses for the aetiology of the reported increases in incidence, or to produce research which is useful to Black and ethnic minority groups, we need a clear understanding of the people under study.

Twenty-five years ago, the Ministry of Health recommended that 20 to 25 beds per million population were needed for treating psychiatrically disturbed adolescents, a figure similar to that recommended by the Royal College in 1956/57. The College also recommended in 1976 the provision of one adolescent psychiatric team per half a million population. None of these norms has been met, nor are they likely to be this century. The decline in the teenage population may slightly reduce the need temporarily until the anticipated increase from the late ‘90s. Meanwhile, government financial restraints call for innovative and creative alternative solutions for the treatment of disturbed adolescents wherever possible without admitting to a residential unit. Indeed the pressure is so great that a number of adolescent units have already been closed, or their beds drastically reduced.

Current neuroscience suggests that although short-term memory difficulties frequently occur immediately after electroconvulsive therapy (ECT), longer-term problems are less common. However, gaps in our knowledge remain regarding longer-term cognitive problems after ECT, including memory function. Some of these relate to the complexities surrounding cognitive testing and interpretation of test results. An important question in clinical decision-making is why, despite current evidence suggesting long-term memory problems are less frequent, some patients still report subjective memory difficulties. To further advance clinical practice and the neuroscience surrounding post-ECT cognitive function, assessment of cognitive function, possibly including neuropsychological testing, should potentially become more routine as part of clinical practice.

This paper is based on experiences over the past three years in North Devon (population 140, 000), a predominantly rural district that until 1986 based most of its psychiatric facilities in a large mental hospital in Exeter, nearly 40 miles away. When Exeter went ‘Italian’, services were devolved to local districts, and North Devon was given the responsibility for providing comprehensive psychiatric care based on a DGH unit, a Day Centre, two hostels and a small multidisciplinary team. No formal psychotherapy services were included in this plan. This is a familiar enough pattern, one that can be found throughout Europe and North America. I shall try to chart the movement from the heady days of decarceration to current uncertainties about community care, a state which might be called post-deinstitutionalism.

Liaison psychiatry in general practice has been recognised as an increasingly important part of the development of community psychiatry. Collaborative working between general practitioners (GPs) and psychiatrists has become commonplace in most parts of the country (Strathdee & Williams, 1984). Different models of liaison have been proposed and a variety of advantages claimed for such work (Mitchell, 1985).

Graduates in the UK are not choosing a career in psychiatry. This paper sets out to do three related things: review the factors that attract and deter medical students from a career in psychiatry, describe the provision of current summer schools and special programmes in psychiatry, and provide detail of how initiatives such as summer schools may be set up, run and evaluated locally to potentially address some of those issues identified in the first section.

The management of mentally handicapped offenders has long been problematic. Three misconceptions of the relationship between mental handicap and criminality have been widely held since the turn of the century, despite there being no conclusive evidence in their support (Jackson, 1983). These are: that mentally handicapped people are more likely than others to commit antisocial acts in general; that they have a particular predisposition to commit serious crime, especially sexual crime (Robertson, 1981); and that they are unlikely to be deterred by normal sanctions. Misunderstanding breeds misapprehension. Sadly, in the past, many mentally handicapped people were admitted to hospital after committing only trivial offences. Moreover, one Special Hospital study (Parker, 1974) found that most “severely subnormal and subnormal” detained patients actually had IQs above the category to which they had been assigned.

Because of the nature of some mental illness, care and compulsion in psychiatry are not always antithetical. However, it is no longer acceptable to link compulsory treatment almost exclusively to compulsory hospitalisation. Treatment should occur in the least restrictive environment possible. This paper looks at experience of extended leave of absence in Scotland, and in England and Wales before 1986, at the recent evidence for an increased risk of violence and homicide in schizophrenia and the danger of a backlash against community care if it is perceived as unsafe, and makes suggestions in relation to research and to provision for treatment in the community in the absence of consent.