Homicide is in the news and community care is being blamed, a view not justified by the facts. Much has been written about the homicides of Johnathan Zito and Georgina Robinson and there has rightly been considerable public and professional concern. There have been other reports on the murder of Johnathan Newby in October 1993 and William Bennett in July 1994. Yet another case is currently the subject of an inquiry and again the press is expressing indignation and horror. The anxiety and concern are natural but the reactions are not justified.

Many psychiatrists now work successfully in the primary care setting. Although a primary care post might be considered to be a useful experience by most trainees, few undertake such an attachment, owing to lacked opportunities and concern that such a placement would delay career progress or be at the expense of psychiatric subspeciality experience (Burns, 1994). For general practice posts to be integrated into psychiatric training, these concerns need to be addressed. One solution has been a post shared with general psychiatry (Balmer, 1993). This paper describes an alternative approach, a post combining subspeciality experience in psychotherapy within the practice setting, with working as a general practitioner (GP) trainee.

Murphy's law states that if something can go wrong it will go wrong. Our recent experience in organising the MRCPsych exam at two centres confirms the general validity of this aphorism. We wish to share our experiences with other senior registrars who may find themselves in a similar predicament.

Between the 15 and 17 of June 1995, Liberty and other organisations concerned with human rights coordinated the Human Rights Convention. This gathering examined the meaning of human rights, why they matter, and how they could be strengthened. In the full programme there was a workshop on mental health. This workshop examined how mental health legislation and practices affect the human rights of psychiatric service users.

Over the past five decades, services for the mentally ill in India have steadily improved. From a predominantly mental hospital based service, provision has now moved to general hospitals and primary health centres. A variety of factors have contributed to changes in the quality of services. This paper briefly reviews the changes and discusses the relevance of some of them.

Although haloperidol (HAL) has been available as an antipsychotic for over 30 years, controversy still surrounds the appropriate dose in the treatment of psychosis and in particular, schizophrenia. In practice, high dose HAL (greater than 20 mg/day) continues to be prescribed, despite good reason for not doing so: the incidence of extrapyramidal side-effects (EPSE) is known to be dose-related; and compliance with treatment may be adversely affected by side-effects, especially akathisia and Parkinsonism.

Public debate on dementia has intensified recently with scientific advances being scrutinised in the media, the genetics of Alzheimer's disease regularly portrayed as inextricably linked with the personal agony of whether to have ‘the test’ (which exists only for a small number of people) and the announcement by ex US President Ronald Reagan that he suffers from the disease. Several different areas provoke interest and speculation and this brief article attempts to highlight some, based on a recent meeting on the subject.

In response to the expressed needs of trainees for training in the planning development, and evaluation of mental health services, a short course was designed and is described here. The course was run several times and proved flexible enough to be presented to either multidisciplinary, inter-agency audiences or to a solely medical audience.

In most Asian countries child psychiatry is still in its infancy and the few specialists operating in this field have received their training overseas, usually in Europe or the USA. There is a perceived need for more expertise in child mental health and the unsatisfactory solution often adopted is for psychiatrists trained in adult work to move in and learn from experience.

The Strathcona Theatre Company is made up of professional actors with a learning disability and two directors. As part of the teaching course in the Department of Psychiatry of Disability at St George's Hospital Medical School, the medical students participate in a workshop given by the Company, near the beginning of their attachment in psychiatry. During the two-hour workshop the students are taught a variety of ‘ice breaking’ games and mimes by members of the Company. This means that early on in the course, students have face to face contact with adults with a learning disability, and furthermore see them in a socially valued role as teachers and leaders. The students usually find the workshop enjoyable, and give positive feedback although they were unsure how successful the workshop was in changing medical students' attitudes towards people with learning disability. We report an evaluation of students' attitudes before and after the workshop, and show statistically significant changes in attitudes towards people with a learning disability.

Educational pressure on children is worldwide. In the United Kingdom this is seen in the growth of structured classes and courses for two- to four-year-olds such as ‘Making French Fun’ and ‘Musical Appreciation for Under Fours' (Matthews, 1995). Such programmes are of particular interest to aspiring middle-class parents but other groups also have high educational expectations. Some parents with a West Indian background, believing the British educational system to be superior to that in their country of origin, look for high attainments which often results in their children showing psychosomatic symptoms. In developing countries the signs of educational pressure are especially evident.

In May 1995 a Conference on Forensic Psychiatry was held near Tel Aviv, to which psychiatrists and other health professionals specialising in forensic psychiatry from Britain and Israel and Palestinians from the West Bank were invited. Participants at the Conference took part in discussions on forensic psychiatry and visited a maximum security prison with a hospital wing at Ramleh and an Arab psychiatric hospital in Bethlehem on the West Bank. On the days between Conference events, the British group visited Jerusalem and the Dead Sea and became aware of the almost unique interflux between Muslim, Christian and Jewish religion and culture which underlies the historical evolution of this area of the world. The modern social and political landscape is of course characterised by a violent confrontation between Arabs and Jews yet permeated now by a growing realisation of the need for peace and reconciliation, even if this has its ambivalent aspects at times. In this context the participation of Jewish and Arab health professionals together is a sign that ultimately medical and health care has its universal qualities which can bridge over or supersede the differences between nations that are so endemic to history.

In 1990 a UK psychiatrist and community psychiatric nurse (CPN) went to Belize, in Central America, to set up a comprehensive mental health service, based on community clinics staffed by psychiatric nurse practitioners. This work was completed by 1992. In 1994 two medical students visited Belize for eight weeks to review the new mental health service.

This article briefly describes the experience of two final year senior registrars visiting services in other regions. The potential training benefits of such external placements for higher trainees are outlined and practical suggestions are made on how to make them more widely available.

During my years in rehabilitation and community psychiatry I have picked up a number of aphorisms which I believe enshrine some of the lasting truths in this field. I have always liked Albert Kushlik's remarks about doctors as the “hit and run” staff in terms of the duration of their contact with patients. But over the years other aphorisms have been brought to my attention by colleagues or students, although I can claim to have coined a couple myself.

November 30th 1995 saw old age psychiatry lose the active services of four men who have played heroic roles in creating and moulding the speciality.

Many sources of evidence inform clinical practice, including research findings, patients' views, and clinical experience. This article describes recent progress in developing what will be the College's first guideline, The Assessment and Management of Violence In Clinical Settings. The design of the programme acknowledges the diversity of evidence in this area, by drawing a distinction between different types of evidence. Evidence is systematically identified and its quality appraised by the Work Group, through commissioning literature reviews. Initial recommendations will be based on experimental data. The methods used to consider non-experimental data, particularly expert opinion, will be described in more detail in a later article in this series.

It has been demonstrated that images of madness in the media powerfully influence the general public and serve to perpetuate popular stereotypes of mental illness (Philo et al, 1993). While the cinema's treatment of psychiatric issues has received critical attention (Gabard & Gabard, 1987), there is one area of film-making that has, so far, been neglected: the work of Walt Disney. Perhaps, because it has been primarily regarded as entertainment for children, Disney's work has not been subjected to serious examination. This neglect, however, is surprising in view of the current debate about the influence of the media on children. When one also considers that Disney films are now available on video and are being seen by millions, it seems worthwhile to look at the images of madness they present.

I would like to describe my brief impressions of psychiatry in Khartoum, Sudan and raise some ethical issues that arose for me there.