The assessment and management of suicide risk are among the most difficult clinical skills to acquire. Seager & Flood (1965)examined coroners' inquisitions on 325 suicides which occurred during 1957â€"61 and found that 4.6% had taken place during in-patient or day-psychiatric care, and 16°lo within six months of receiving such treatment. More recent work

Capgras' syndrome presenting as post partum psychosis.

A case of cerebral lupus is described over a three year period. The association of chronic brain syndrome, symptoms of derealisation and a suicide bid has not been reported previously. A hypothesis integrating organic and functional symptoms is suggested.

I had acquainted myself with the psychiatric services in New Zealand some years ago during my student elective. I wanted to return to experience further a system which was both similar and different to the NHS. The New Zealand hospital system was funded in a similar way to the NHS. One organisational difference was the managerial layer, which was still filled by medical superintendents. Another difference was the extensive no-fault accident compensation scheme through which settlements were made without resort to lawsuits. Thus doctors paid low medical defence fees and were rarely sued, but the Government had regularly to meet a large bill. The psychiatric services were in the process of moving from hospital-based to community-based, in line with prevailing clinical and public attitudes. This was fuelled by some headline-making scandals over patient care in the asylums. One cause for general alarm was the poor health of ethnic minorities, especially the indigenous Maori. This issue resonated with racial and political overtones.

well supervised situations. It also helps the under standing of adult patients' descriptive histories. Knowledge of developmental, family and service interaction issues can allow trainees to reappraise the context of the histories of adult psychiatry patients, not only of those patients' adolescence but also of the situations in which the patients now find themselves. Despite College recommendations, many trainees may not have the opportunity to complete their train ing by having worked with children or particularly with adolescents as a specialist placement. ARTUROLANGA Leavesden Hospital Abbots Langlev Watford WD50NU References HAS (1985) Bridges over Troubled Water. Sutton: Health Advisory Service. ROYAL COLLEGE OFPSYCHIATRISTS (1983) Providing a dis trict service for child and adolescent psychiatry: medical manpower priority? Bulletin of the Royal College of Psychiatrists, 7,94-97. (1990) A statement on approval of training schemes for general professional training for the MRC Psych.