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A case of senile dementia that initially presented with complex visual hallucinations in the absence of clinical cognitive impairment or other psychopathology is described. Dementia must be added to the differential diagnosis of isolated visual hallucinations in the elderly.

Two consecutive cohorts of medical students who received their fourth year psychiatry training at Manchester University completed knowledge and attitude questionnaires on ECT at the start and conclusion of their clerkships. Their understanding and knowledge of ECT was shown to be greater at the end of the clerkship and their attitudes towards treatment were more positive. The second cohort received an extra teaching session on ECT but this did not confer any additional benefit. It is concluded that increased contact with and knowledge about the treatment has a positive effect on medical students' attitudes. There is still room to improve teaching about ECT.

An instrument was designed to rate the administration of electroconvulsive therapy. The performance of junior doctors was rated before and after videotape training in technique. The group showed a marked increase in ratings following training. The limitations and importance of the study are discussed.

Patients' attitudes towards electroconvulsive therapy (ECT) on their completion of a course of treatment were studied using a semi-structured questionnaire. Twenty-six patients were seen before the junior doctors were trained in ECT administration and 28 patients afterwards. Most patients' attitudes were favourable, although very few fully understood the treatment. Training the junior doctors had no effect on patients' attitudes, but was associated with a shorter mean course length. ECT was acceptable to most patients who received it.

Electroconvulsive therapy is an important treatment in the depressive states of late life, and there is general agreement about the indications for its use in old age psychiatry. Indeed, old age may be associated with a better response to ECT than that in younger age groups. The additional risk involved through physical problems in the elderly is not great when compared with that of continuing depression and of the side-effects of alternative treatments. Temporary memory disorders and confusion may occur, but are minimised if unilateral electrode placement is used. Some patients treated with unilateral ECT do not respond, but will respond to bilateral treatment. Anxiety over unwanted treatment effects, which can lead to ineffective treatment of depressive illness, must be outweighed by knowledge of the dangers of leaving depression untreated in old age.