The misuse of alcohol causes a range of health, legal, social and employment problems for the individual and the rest of society. Many agencies are involved in dealing with the consequences of alcohol misuse and providing services to those with problems. Sources of funds to finance interventions for drinkers whether from health authorities, social services, probation or other sources are very limited. Without some coordination there will be a tendency for each funder to shift responsibility and costs. These difficulties have been recognised and in 1989 a government health circular was issued emphasising the need for the development of local multi-agency alcohol misuse prevention strategies. Implementing policies such as community care and Health of the Nation also require multi-agency co-operation if they are to fulfil their aims. The survey of the development of local alcohol strategies reported in this paper (Wallace et al, 1993) is therefore of great interest.

The Commission welcomes the opportunity to comment on Dr Oyebode's paper. As a former medical member of the Commission, Dr Oyebode can write with authority on the frustrations felt by many Commissioners when carrying out their statutory obligations to ensure that the requirements of Section 58 of the Act are being met. His paper is particularly opportune considering the recent publication by the Law Commission of its consultation paper No. 129 (Law Commission, 1993).

A leading article in the British Medical Journal (Miller, 1992) comprehensively criticised the Joint Planning Advisory Committee (JPAC) for failing to implement the changes in manning levels needed for Achieving a Balance. This leader came as no surprise to psychiatric trainees, and nor did it offer much comfort. The ‘bottleneck’ between registrar and senior registrar has become a ‘log-jam’ and although prospects for trainee psychiatrists are not as bleak as for the unfortunate would-be thoracic physicians cited in the leader, they are bad enough. For example, when a single SR post in adult psychiatry was recently advertised for the NW Thames region, there were over 60 enquiries, 45 of which transformed into definite applications, even though the post offered was in a less than popular sub-speciality. Local selection committee members for NW Thames in other psychiatric specialities have also been surprised by the number of applicants. JPAC may not be entirely to blame: the economic recession may be a disincentive for consultants wishing to retire early, thus slowing-up career progression throughout the profession.

Although the EEG has been in constant clinical use for over 40 years, there have been surprisingly few systematic studies of the pattern of referral and clinical use of electroencephalography in a NHS psychiatric service. In view of the current concern about medical audit and cost effective use of special investigation facilities, it is an opportune time to audit the use of clinical electroencephalography in psychiatry. The current study examines the clinical use of electroencephalography in a district psychiatric service that provides comprehensive care for the population of Dundee (population 180,000).

The following recent murder trial at a Scottish High Court raises some points of interest to all UK psychiatrists in relation to the use of brain imaging test results as psychiatric evidence and their relevance to the question of diminished responsibility. It should be noted that in Scotland diminished responsibility has a much narrower scope than that encountered in the England and Wales (Chiswick, 1991) and is dependent upon the presence of a “mental disorder or a mental illness or disease” (Connelly v HMA 1990).

The concept of personal time management does not, perhaps, generate immediate enthusiasm among junior doctors: the terminology seems somewhat alien and the idea more relevant to the world of business than that of clinical practice. There is a lack of coverage of this issue in the citations concerning the applications of time management to the medical profession. Although allied professions have made an attempt to address the matter (Shubin, 1988), they have tended to concentrate more on personality types (McAlvanah, 1989) and obstacles to effectiveness (Sheridan, 1988), rather than providing practical guidelines.

On 28 March 1990 a BBC television programme in the ‘QED’ series was broadcast entitled ‘The Last Resort’. It sympathetically showed the life of a woman with a treatment resistant affective disorder and later presented some aspects of her treatment at this unit, including a stereotactic subcaudate tractotomy (SST) operation. As a result of this programme a number of patients wrote to us and this report compares referrals arising in this way with a sample of referrals to the unit through the usual channels.

During 1991, only 0.54% of all admissions to All Saints Hospital (ASH) were under section 4 of the 1983 Mental Health Act (MHA) (England & Wales), representing 2.63% of all admissions under the MHA. These figures compare favourably with other published studies. This paper looks at possible reasons for these low figures and reports on an audit of those few admissions against the criteria laid down in the MHA.

Otto Dix (1891–1969) was a leading German Impressionist painter whose major work was associated with the Weimar Republic period, although his art extended from before to after both world wars.

An active interest in research aids understanding of research methods helps in the reading of scientific papers, and is rapidly becoming a prerequisite for career progression in psychiatry.

A recent report by the Royal College of Psychiatrists (1993) on community supervision orders refers to the use of extended leave in Scotland. The legal basis for this practice is uncertain, and some explanation is required.

The main source of topical information in most parts of the world is through the mass media – principally newspapers and television. Television news and current affairs have a duty to remain impartial, as they provide a service for the whole population. Newspapers, on the other hand, have a greater journalistic and editorial freedom as they target subgroups. British newspapers are currently being scrutinised as to how they report both factual and speculative information of a general kind. At the same time there seems to be an increase in their interest in psychological matters. However, work on newspaper reporting of psychiatric disorders (Day & Page, 1986; Matas et al, 1986) has shown that the mentally ill are usually portrayed in a rather negative light with few positive images.

As a consultant in the psychiatry of learning disability for the past 18 years, I had assumed that the Mental Health Acts referred to those patients who have some understanding of the concept of treatment and who are able to clearly express an objection to any proposed management. Those who could not express an objection because of severe handicap (“non-volitional patients”), I treated as informal patients. This view was supported by a representative of the Medical Protection Society, with whom I had discussions soon after I became a consultant. It agrees with the assumption that is widely held that for informal admission to occur, a person need not express positive willingness to be admitted to hospital, that it is sufficient that he is not unwilling to be treated in hospital (Gostin, 1983).

With the current balance of manpower, being appointed to a senior registrar post is seen as more of a hurdle in the NHS career path of junior psychiatrists than the MCRPsych examination. Numerically, it is the most significant bottleneck in the system, with substantially more suitable applicants than available posts. One effect that this has had is to encourage a climate where rumours and myths circulate about what is necessary to become an SR. As well as being stressful and demoralising, this can give candidates the wrong ideas of what is realistically required.

Over the last 20 to 30 years, the team, multidisciplinary, approach to psychiatry has become firmly established. Proponents would argue that it is essential that a patient has the benefit of the different knowledge bases, skills and approaches, which come from the various professionals forming the clinical team. Using the common Gestalt concept, one might hope that a well-functioning team would exceed in its therapeutic effectiveness the sum total of the skills of its individual members. Such a team should be able to communicate well, draw freely from particular skills of members and be able to adopt a consistent approach in its relationships and interventions with patients. This, however, is not always the case. In my experience, it is not uncommon for clinical teams to suffer from unresolved conflicts between their members. Such conflicts can diminish the team's overall potential and make difficulties in adopting a consistent approach with patients. When conflicts are severe, the clinical team can sometimes exacerbate, through its own chaotic element, the disturbances in the minds of its patients. In this extreme, patients may be pulled into staff conflicts and used to augment one side or another of a particular staff difference. This paper argues that for the clinical team to endeavour to reach its maximum potential, there has to be a reasonable degree of resolution and agreement around three ‘constructs’ of potential conflict: ideology, power and boundaries.

L-tryptophan is an essential amino acid in human nutrition. The minimum daily requirement for adults is in the range of 175 to 250 mg daily and this is normally exceeded in the average western diet which contains 600 to 1000 mg. Excess tryptophan is normally metabolised through the kynurenine pathway and only 1–2% of tryptophan in the diet is converted to 5-HT. The concept that 5-HT had a part to play in depressive illness evolved after the original observation by Ashcroft & Sharman in 1960 that patients with severe depressive illness had lower levels of the metabolite of 5-HT in cerebrospinal fluid compared with controls. In addition, early papers on the therapeutic efficacy of tryptophan suggested that it was potentially as successful as ECT.

Early in 1992, two articles were published on the subject of multidisciplinary teams in child and adolescent psychiatry. In the first, Mathai (1992) challenges the “accepted multidisciplinary model” as being “unworkable”. He comments that in many teams an appearance of multidisciplinary working can hide covert conflicts and goes on to propose that all referrals should be made to the consultant psychiatrist who will then decide to whom these referrals should be allocated within the team.