The number of people following a vegan diet in the UK is increasing. Eating disorder clinicians are anecdotally reporting that more of their patients with anorexia nervosa are wanting to follow a vegan diet. The relationship between veganism and eating disorders is unclear. A fictitious scenario is used to explore these issues. An approach is described that clinicians may follow to help patients to understand the potential relationship between their eating disorder and veganism. The human rights issues this involves are also explored. It is hoped that this article will make readers more aware of this complex issue and the impact it can have on engagement with services and on treatment options.

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.

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).

The Italian Reform Act (Law 180) has been considered one of the most revolutionary Mental Health Acts in Western countries and has been the subject of considerable attention since its promulgation in May 1978. Interest in the Italian model of community psychiatry has been reflected in the number of articles, special supplements and letters, published in noteworthy European and American journals. However, for a better understanding of the meaning of Law 180 (now part of Law 833 concerning general health measures) the political and sociocultural climate surrounding the enactment of the Italian Mental Health Act should be considered.

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.

The predictable pharmacokinetic drug interaction between clozapine and rifampicin is listed in most standard reference texts but little detail is given or emphasis on its clinical significance. The interaction is based on theoretical knowledge of both drugs; to date just two case reports have been published. This article describes a third case demonstrating the significance of this interaction. This was potentially devastating for the patient who required an extended psychiatric admission. The enzyme induction was so potent that the dose of clozapine had to be increased approximately sixfold. Careful management of this significant interaction is essential for effective patient care.

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.

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.

This article highlights key findings from a recent Royal College of Psychiatrists project showing that many UK medical schools are embracing the dual challenge of raising students’ interest in psychiatry and ensuring that all doctors can support patients with mental illness. It focuses on two novel approaches to boosting recruitment into psychiatry: I'm a Medic Get Me Out of Here, an online outreach activity enabling schoolchildren to ask questions of health professionals in real time; and a living library, which creates a safe space for dialogue where topics are discussed openly between human books (professionals) and readers (undergraduate students) to challenge stereotypes. It is recommended that sharing these and other examples of good practice will help all medical schools encourage recruitment in psychiatry more widely.

Bailly's review describes the author's perspectives on the ‘intense controversies' surrounding attention-deficit hyperactivity disorder (ADHD) and its treatment with stimulant medications. Drawing on a range of literature sources, including the UK press, pharmaceutical industry websites and peer-reviewed scientific papers, he questions the validity of ADHD as a concept and disorder, the accuracy and reliability of diagnosis, the use of stimulant medications and the impact of advertising by the pharmaceutical industry. There are, however, additional sources and alternative interpretations.