People with learning disabilities form only a small part of the general population, but because of their many special needs, they require the provision of specialist health services. National statistics on the prevalence of learning disabilities are poor, but it has been estimated that 160 000 people in England and Wales have severe or profound learning disabilities (Audit Commission, 1987).

Treatment of trauma has been already covered in this journal (Adshead, 1995) and elsewhere (Davidson, 1992; Kleber & Brom, 1992; Wilson & Raphael, 1993). However, there are situations where the trauma can become extensive and chronic, sometimes called Type II trauma (Terr, 1991), necessitating additional therapeutic considerations. Such situations are not uncommon in the world today, frequently occurring during wars that are typically ‘low-intensity’ conflicts involving poor, Third World countries. It has been estimated that there have been over 150 such wars since 1945, in which 90% of all casualties are civilians. According to Summerfield (1996), what predominates is the use of terror to exert social control, if necessary by disrupting the social, economic and cultural structures. The target is often population rather than territory and psychological warfare is the central element. Atrocities, including civilian massacres, reprisals, bombing, shelling, mass displacements, disappearances and torture are the norm. The consequences for mental health, not to mention the social, economic, cultural and other costs, can be substantial.

The early treatment of newly diagnosed schizophrenia has ramifications for the future psychiatric and social well-being of the patient. Changes in care structures and care delivery mechanisms, in addition to financial constraints and outcome targets, provide an additional incentive to ensuring that any intervention is both successful and cost-effective.

At most, 15% of patients in Western countries remain free of relapse after their first episode of schizophrenia (Crow et al, 1986). Like many chronic illnesses, schizophrenia can be controlled by appropriate treatment, but there may be a gradual deterioration over time. This encompasses problems such as loss of self-care, communication and community skills; negative symptoms of poverty of affect and ideation; cognitive impairment; behaviour problems such as aggression; and poorly controlled positive symptoms.

‘Educational supervisor’ is the term now used by the General Medical Council for a consultant who has junior doctors working with him/her, whether employed by the National Health Service or a university. This paper represents our views of the role of the educational supervisor, rather than official College policy.

Seasonal affective disorder (SAD) is a recurrent depressive disorder in which episodes occur at a particular time of year. The most frequent variant is winter SAD in which patients become depressed during the autumn or early winter, with remission or conversion to hypomania the following spring. Recognition of winter SAD is important because the diagnosis predicts a good response to the novel treatment of phototherapy. One other variant, summer SAD, has also been described and we will discuss this condition separately. Otherwise, we will confine our discussion to the winter variant which we will refer to as SAD.

In recent years, there has been growing recognition of the significant incidence of child abuse and neglect in the population, and of its adverse effect on the development of children and their mental and physical health. This awareness has led, especially following the implementation of the Children Act 1989, to an increased demand for psychiatric assessments of children for the courts by social services, solicitors, guardians adlitem and the courts themselves. There has been some reluctance to take up this work, for two main reasons. First, there has been concern that these time-consuming assessments will result in a shift of resources away from treatment, thus having an adverse impact on the balance of child mental health services. In some areas, the need has been recognised within the commissioning and contracting processes. Provision has been increased accordingly, acknowledging that it is part of the responsibility of the health authorities to assist the local authorities in this way.

Rapid-cycling bipolar affective disorder presents a unique spectrum of therapeutic difficulties. This article outlines some practical guidelines on the assessment and management of the disorder in the light of current research and clinical practice.