Akathisia is a distressing movement disorder associated with neuroleptic medication. Patients complain of a feeling of inner restlessness (Barnes, 1989). The characteristic signs include constant moving when seated, rocking from foot to foot and pacing (Adler et al, 1989). Neuroleptic-induced akathisia (NIA) is usually an acute reaction, but a chronic akathisia can occur after prolonged treatment with neuroleptics (Fleischhacker et al, 1990). It has been suggested that chronic NIA is related to tardive dyskinesia, and that like tardive dyskinesia it is difficult to treat (Blaisdell, 1994). Reducing the neuroleptic dose may ease the symptoms (Barnes, 1989). Other options include using an atypical neuroleptic, which may cause lower rates of akathisia (Poyurovsky et al, 1999). Biochemical and pharmacological evidence has indicated the importance of serotonin in controlling movement (Bersani et al, 1986). Serotonin antagonists, particularly mianserin, ritanserin and cyproheptadine, have been used to treat NIA. This article reviews the published trials and case reports retrieved by a Medline search from January 1985 to August 1999.

This article explores some basic questions about management and reveals that psychiatrists may already have a head start in management. The aim is not to make good psychiatrists into managers, but to enable good psychiatrists to provide good mental health care.

This site summarises systematic reviews of randomised trials by searching Medline and Pubmed. Bandolier Knowledge Bazaar assembles stories from Bandolier under discrete headings, such as ‘healthy living’.

The undergraduate medical education in Denmark consists of six-and-a-half years of (mainly) academic studying. A combination of sabbatical years and late-starters pushed the average age of the medical candidate to 30 in 1998. Well over 50% are women.

Robert Burton was an Oxford clergyman and scholar. His book was first published in 1621. He adopts the title Democritus Junior after the Greek philosopher who was also “an expert physician, a politician, and an excellent mathematician“. Hippocrates described him as “a little wearish old man, very melancholy by nature”. In the preface, the author says: “I write of melancholy by being busy to avoid melancholy.” (Burton, 1621)

There is growing emphasis on the importance of continuing professional development (CPD) for consultant psychiatrists and an increasing recognition of the need for peer support. In this context the Royal College of Psychiatrists has been developing policy around CPD; a policy document has been issued by The College Council (Royal College of Psychiatrists, 1994) and there are regular updates on this topic on the website (www.rcpsych.ac.uk). All consultants are to be expected to take part in CPD and currently the annual requirement is for 20 hours of ‘external’ CPD and 30 hours of ‘internal’ CPD. ‘External’ refers to didactic or workshop events that involve input from outside a clinician's locality; ‘internal’ refers to local activities, case conferences, journal clubs, etc. CPD follows a 5-year rolling cycle, supported by the journal Advances in Psychiatric Treatment, a recommended 2 hours per week personal study and the development of personal development plans. From the outset there appear to have been issues in engaging consultants in CPD (Morgan, 1998). The problems of establishing CPD extend beyond consultants ‘finding the time’.