No abstract

In the wee midnight hours, long ‘fore the break of day In the wee midnight hours, long before the break of day When the blues creep upon you and carry your mind away.

Advertisers use powerful images to sell everything from cars to coffee, from banks to baked beans. That this should also apply to pharmaceuticals then is unsurprising. Whatever view we as clinicians might take of drugs, for their manufacturers they are a product like any other, and doctors are the natural targets for their promotion. In 1982 the pharmaceutical industry spent £150,000,000 on drug promotion in the UK (Medawar, 1984). We have attempted to take an objective view of drug advertisements by examining the images used in all the advertisements that have appeared in the British Journal of Psychiatry over the last 30 years.

The decision of the Law Lords in May 1989 that allowed the sterilisation of a woman with serious mental handicap (F. v. W. Berkshire H.A., 1989) is arguably the single most important legal development in relation to psychiatry in the last 30 years. It has far-reaching implications beyond the field of mental handicap and will affect the practice of all psychiatrists. The Law Lords used the appeal to consider “the startling fact that there is no English Authority on the question whether as a matter of common law (and if so in what circumstances) medical treatment can lawfully be given to a person who is disabled by mental incapacity from consenting to it” (Lord Goff). Quite clearly this encompasses a large part of psychiatric practice and promised to clarify much of the controversy surrounding consent and the incompetent patient. The decision that they reached has now been incorporated into the Code of Practice of the Mental Health Act 1983 which was approved by Parliament in December 1989. The effects of this are of huge importance, and it has extensive consequences for all psychiatrists and their patients by simplifying the legal aspects of treatment. The most surprising aspect of this whole issue, therefore, is the silence that has surrounded both the original decision by the Law Lords and the subsequent publication of the Code of Practice. The only reference to these in The British Journal of Psychiatry, or its sister journal, Psychiatric Bulletin, has been a brief letter outlining some implications of the Lords' decision (Lovett, 1989). This is doubly surprising as the Royal College of Psychiatrists has shown considerable interest in this debate, not least by publishing a book about it! (Hirsch & Harris, 1988). The purpose of this paper is to provide a background to the Code of Practice and to clarify certain issues surrounding the Common Law.

There has been controversy about the efficacy of pregabalin for some indications, as well as the potential for misuse and adverse effects. Here, the authors discuss a female who was admitted with symptoms of severe depression and psychotic features with a potential causation of discontinuation of pregabalin that had been used for several years. due to chronic back pain.