This study explores the outcome and longer-term sequelae of suffering chronic fatigue syndrome in childhood. Ten such children, ranging from 10 to 16 years of age at diagnosis, were followed up into adulthood, an average of seven years. Most were completely well or markedly improved (seven of nine). Only children fully engaged in therapy made a total recovery. However, respondents felt medical staff did not believe their symptoms and that rehabilitative strategies were unhelpful. No physical or mental illness was subsequently diagnosed to account for the original symptom presentation. Childhood sufferers maintained the same pattern of symptoms as adults. Depressive symptomatology was present in two cases. The overall longer-term prognosis for children suffering chronic fatigue syndrome is good. A successful doctor-patient relationship is essential to improve compliance with management plans.

General practitioners in a south London health authority were sent a questionnaire about their experience and views concerning the treatment of childhood chronic fatigue syndrome. Most thought childhood chronic fatigue syndrome had a significant psychological component, but opinion was divided over referral to a psychiatrist. The involvement of self-help organisations was supported but the place of rest and exercise unclear. The optimum primary care management of childhood chronic fatigue syndrome needs to be established.

The reduction in psychiatric beds over the past few decades has coincided with burgeoning homelessness in the UK. What effect has this had on the provision of in-patient care to this neglected section of the population? Admissions of people of ‘no fixed abode’ in Birmingham were compared for the years 1961–1964 and 1995–1996. Both the number of admissions and duration of in-patient episodes had decreased and many patients continued to receive no aftercare. Solutions to the problem of homelessness among the severely mentally ill must address failings in hospital as well as community services.

We investigated the detection and awareness of child sexual abuse by examining case notes. Child sexual abuse was recorded in 4.7% of cases. There was no evidence that enquiry about child sexual abuse or detection of the problem had increased in recent years, and recording of the details of abuse was rare. Victims received more psychological help and less medication than others. We conclude that awareness of the issue has not increased. Previous findings about child sexual abuse are rarely used in evaluation, and diagnosis and drug treatment may be overlooked in some victims.

Child and adolescent mental health services operate at four tiers. An eating disorders service is a tier 3 function and in the usual absence of specific funding has to operate from within current resources. The operation of an eating disorders team within a wider child and adolescent mental health service has significant advantages. The operation of such a team is explained and the advantages discussed.

This retrospective study looks at the outcome of 71 consecutive liaison referrals. Placement was noted at three-month follow-up and further use of medical, psychiatric and social services, compliance with clinical management and recommendations was also measured. Nearly half the patients had dementia and about half had a functional disorder. In 90% of referrals the recommendations were followed. At three-month follow-up 17% had died, 26% had further medical hospital admission, 39% had moved into a continuing care facility (residential/nursing home), and over half had further contact with the old age psychiatry services.

A survey of people with schizophrenia in an inner-city general practice was undertaken to identify levels of social disability, service receipt and patterns of care received. Contacts with general practitioners, psychiatrists, community psychiatric nurses and social workers were quantified, and the nature of the contacts assessed. Overall social disability for the group was marked (mean Health of the Nation Outcome Scales (HoNOS) rating 55.5). There was a correlation coefficient of +0.899 between the numbers of agencies involved and the overall HoNOS scores suggesting appropriate targeting of care. While there were few differences in the HoNOS ratings of the various contact subsets, there were significant differences in the extent of agencies contact with patients, the greatest number of contacts being in general practice. Limited information sharing, the absence of a formal shared care plan and sectorisation of services are thought to obstruct more effective general practice involvement in care.

This study surveyed north-west consultant psychiatrists regarding their clinical electroconvulsive therapy (ECT) practice. A postal questionnaire was sent to all consultants identified by contacting north-west hospitals. Most respondents were in favour of using ECT, primarily for depressive psychosis. Bilateral ECT, twice weekly, was the preferred means of administration. Practice was similar overall to Pippard and Ellam's findings in their national survey. Prior to the latest College ECT guidelines, there had been little change in clinical ECT practice in the north-west since Pippard and Ellam's national survey.

In this study we explored the views of 245 opiate users attending a regional drug dependency unit about decriminalisation of drug use and their perception of the consequences of free availability on themselves and society. Contrary to expectation, opiate dependent individuals were not in support of decriminalisation but favoured controlled availability.

This is a follow-up of 24 cases of guardianship orders, and demonstrates how they can be used in practice for complex cases and highlights practical problems with the process of guardianship. Results showed that orders were generally applied to elderly females with dementing illness living alone. Many orders resulted in a move to residential care where the orders were often left to lapse within six months. Occasionally orders needed continuous renewal and here the process was often haphazard and disorganised. However, guardianship was used to coordinate and facilitate multi-disciplinary care. Difficulties have since been identified and improvements in organisation are discussed.

The ability of elderly patients to identify a nurse wearing a uniform as opposed to mufti was investigated together with the effect of administrator attire on the Abbreviated Mental Test score (AMT). Thirty-six out of 71 patients identified a nurse wearing mufti increasing to 59/71 when wearing uniform (P < 0.005). Patients rated by a uniformed nurse had significantly higher mean AMT scores (6.1) than when rated by a nurse in mufti (5.6) (P < 0.01), and this also had a significant effect on the sensitivity in predicting an organic diagnosis.

This article summarises the findings of a National Health Service Executive, Royal College of Psychiatrists', National Association of Health Authorities and Trusts, and Trust Federation working group on medical staffing in mental health, which reported to ministers in summer 1996 and was launched at a conference in November 1996 jointly with the College. Although primarily focused on England and Wales, it is clear that similar problems exist in other parts of the United Kingdom and the Republic of Ireland.

For many involved in the management of people with personality disorders the title of this article may appear to be a contradiction; drugs may alter mental state but intrinsically seem unlikely to alter personality. Nevertheless, drugs are available for treating personality disorders (even though none of them are licensed for these conditions). So it is hardly surprising that there is now a considerable body of literature on the subject which has recently been extensively reviewed (Stein, 1992) but which has attracted more attention since personality disorders have achieved greater prominence in all parts of psychiatric practice.

When invited to give the Maxwell Jones lecture as part of the Fiftieth Anniversary Celebrations of the Henderson Hospital I was pleased and honoured, as well as somewhat surprised. I welcomed the opportunity to pay tribute to an outstanding social psychiatrist and to reflect on a decade of turbulent change within mental health services.