Fourteen general practice trainees took part in a course specifically designed to improve their psychiatric interviewing skills. The trainees were instructed in the problem-based model and were taught in a group setting with the use of videotape feedback. A significant improvement was demonstrated in the trainees' ability to identify psychiatric illness accurately, and there were significant changes in their interview behaviours after training. Those who were below average before training showed the greatest improvement. The implications of these findings are discussed. Group video feedback training is as effective as one-to-one video feedback training in improving the psychiatric interviewing skills of GP trainees, and could be more widely employed in general practice vocational training.

A problem-based approach which can be utilized in general practice for 'diagnosis and treatment' is described. The various related phases and probable components have been defined, starting with problem sensing, problem detection, problem description and then proceeding to problem assessment and problem-oriented intervention and evaluation. This approach is empirical, patient-centered, geared to general practice, easily acquired and may well have utility in other fields of medicine. Investigation of its effectiveness and efficiency as well as its ability to be taught is needed.

A unique 8-year training programme for 110 family medicine residents is described. The psychiatrist works in a family medicine setting with the staff doctors, residents, and patients. The approach evolved because patients wanted a brief problem intervention, and because doctors wanted rapid and efficient methods to identify and treat problems, without using a psychodynamic model. For empirical data collection and clear problem description, a behavioural model is employed. For assessment and therapy, a problem-orientated approach is emphasized, which is rapidly acquired and effectively applied. 'Diagnoses' are not used unless relevant, and paradigms or methods of handling common patient problems are employed. The residents learn in groups and develop skills through supervision of actual patient encounters. There is a phase progression of skill acquisition which is reinforced by the staff doctors. Eighty-seven per cent of the residents achieve the required objectives, and can apply and utilize an approach geared to the needs and realities of everyday practice.

The author treated seven bipolar patients over seven years whose presenting problems were chronic marital conflict. The bipolar diagnosis had previously been made in only one case. Conjoint or family assessment was essential for accurate diagnosis. Lithium was the cornerstone of treatment and the best results were obtained with bipolar patients who were lithium compliant and whose marital conflict was resolved in conjoint therapy. Marital conflict clearly preceded the bipolar disorder and was not prototypical. Neither a family systems model nor a psychopharmacological model alone were sufficient for treatment. The diagnosis of bipolar disorder must be considered with chronic marital conflict.

P sychiatry and family medicine have a natural affinity, often working with overlapping patient populations (1-3). Family physicians may spend up to 50% of their time dealing with emotional problems (4-7), but are likely to refer less than 10% of these cases for a psychiatric assessment or treatment (8). Studies offamily physicians have indicated that most believe they would benefit from additional input or advice around cases that do not necessarily require continuing psychiatric care (9-11).Unfortunately the working relationship between psychiatry and family medicine does not always encourage such involvement (12,13 There are some common features that characterize the McMaster approach. i) It aims to increase the comfort and expertise of family physicians in handling the psychiatric and emotional problems they see on a regular basis in their daily practice. ii) The family physician is actively involved after their patient is referred to psychiatry. iii) Psychiatric services try to offer a range of relevant services that supplement those the family physician is able to provide. iv) There is an awareness of the problems that can arise when the two specialties work together and of the need to monitor and correct these as they arise. v) Above all, we have accepted that if family physicians and psychiatry are to work together effectively, psychiatric services have to take a disproportionate share of the responsibility for initiating and maintaining these contacts.In developing this approach, 8 important guiding principles have evolved. These are:1. To understand the needs of family physicians and the pressures they face. 2. To offer relevant clinical services in a variety of locations. 3. To encourage personal contacts with family physicians. 4. To utilize a problem-based approach. 5. To develop and refine the additional skills required when working with family physicians. 6. To maintain regular communication about patients being seen. 7. To monitor the interface between psychiatry and family for any problems, resolving them as quickly as possible. 8. To use clinical contacts as educational opportunities.