This study investigates the effects of assigned diagnostic labels, with their accompanying predictions of therapeutic response, and prescribed psychotropic drugs. It was thought that such ‘labelling’ effects might be important in ambiguous situations, such as neurotic anxiety–depressive states, where diagnoses of ‘reactive depression’ or ‘anxiety state’ might justifiably be made and treatment with either diazepam or nortripyline legitimately given. The depression label and its concomitant two-weekly prediction of improvement with antidepressants produced a set towards slower response with higher self-report depression. Nortriptyline produced significantly more improvement in self-report depression than diazepam in the first 2 weeks of treatment. No significant interaction effects were detected between diagnosis or drug. One month after the initial diagnostic evaluation there were no significant effects from either diagnostic label or drug.

A questionnaire was developed to elicit medical students' attitudes to psychiatry. All 94 second year clinical students at a London teaching hospital completed the instrument before and after an 8-week psychiatric clerkship. Although two-thirds of the sample had mixed feelings about psychiatry initially, by the end of the clerkship the students' general attitude to psychiatry had changed significantly in a favourable direction. Analysis of 18 specific attitudes to psychiatry revealed that the students' first responses showed anticipatory bias and lack of uniformity. Later, however, only two specific attitudes had changed significantly: more students agreed that ‘problems presented by psychiatric patients are often particularly interesting and challenging’, and more of them disagreed with the statement that ‘psychiatric patients, generally speaking, are not easy to like’. The sexes differed on one attitude; more males than females agreed that “psychiatry is too inexact; it seems to lack a proper scientific basis”. Finally, the proportion of students who considered the possibility of specializing in psychiatry rose from 6 to 17% during the clerkship. The students' reasons for or against such a career are discussed.

Since 1977 there have been two major developments in the provision of services for the ‘new‘ long-stay in Camberwell – a hospital-hostel and an associated supervised group-home. This paper looks at the impact of these services over a 5-year period on a group of patients who fulfilled the ‘new’ long-stay criteria at the end of 1977. Both services appear to be extremely successful in containing such disabled patients. The results suggest that some improvements in patients' handicaps can be achieved and that some patients can be discharged with intensive psychiatric support. Excluding those patients in Special Hospitals, only one person was discharged to and has remained in unsupervised accommodation within the 5-year period.

The paper illustrates drawbacks of the popular cross-over design in clinical trials in psychiatry where treatment effects become distorted by, and confounded with, the effects of their order of administration. It is argued that research workers should analyse data from cross-over trials for asymmetries due to order of treatment and seriously doubt the reliability of data if such effects are found. The problem is avoided by the use of separate-groups designs.

The question of where to place the chronically mentally disabled in the community is essential in this era of brief hospitalization practices. This report examines the effects of the social conditions of the environment on the length of stay in the community for a sample of 119 multiple admission schizophrenics in New York City. Patients returned to a variety of family and non-family living arrangements in poor and depressed areas of the city. The relationship between characteristics of the living arrangements and the patients' clinical functioning and rate of rehospitalization was examined. The findings show that there is no significant differential effect of the type of living arrangement on rehospitalization or clinical functioning, and that these factors did not contribute significantly to the prediction of successful adjustment. However, the socio-emotional characteristics of the environment - i.e. social support and interpersonal stress - together are stronger predictors of outcome than are available out-patient treatment programmes. The findings emphasize the importance of environmental variables as factors independent of the effect of treatment on rehospitalization.

A year's follow-up study of day-hospital long-attenders underlined doubts as to the adequacy of service provision in urban areas of England and Wales for the increasing numbers of chronic psychiatric patients living in the community. Very few of the 82 men and 53 women were married or capable of employment, and both psychiatric and physical morbidity were high; 2 young men committed suicide and 3 elderly men died within a year of discharge. Over the age of 45 men tended to be socially isolated and over the age of 60 they were also physically ill; a number probably required better residential care. Few women under 45 attended, possibly because the services offered were unacceptable.

In a prospective controlled investigation chronic patients, the majority with neurotic conditions, were randomly allocated either to community psychiatric nurses (CPN) as the main therapist or to routine out-patient psychiatrist follow-up. There was no statistically significant difference in the mean public expenditure for the two modes of care. The direct costs of psychiatric care comprised a small proportion of total public expenditure and were initially greater in the nursing group. Subsequently, and over the whole 18-month study period, nursing was the cheaper option in terms of these direct costs. Clinical and social outcomes were comparable in both follow-up groups. Consumer satisfaction was significantly greater among CPN patients. On balance, these results confirm the benefit of community psychiatric nursing for this patient group.

A comprehensive, representative cohort of 121 schizophrenics from a delimited catchment area, hospitalized in the course of 20 months (1973–4) and who met PSE criteria, was collected for a therapeutic trial (1976–6) in which, during the year after discharge, standardized clinical and social assessments has been made by personal interview at home. Standardized observations were repeated 4 years later. Follow-up was 99% complete. 48% of the cohort and 58% of the first admissions had a good outcome. Females fared significantly better than males.

Relatives of 39 schizophrenic patients attending a day hospital in South Glamorgan assessed the patients‘ behaviour at home covering a period of one week. The results pointed to the existence of a sub-group of patients with severe behavioural problems. These patients had had more psychiatric admissions, and had spent a longer total time in hospital. The proportion of forms of behaviour regarded as problems by the relatives themselves was lower than that suggested by their assessments, except in the families where the patient exhibited severe behavioural difficulties. The findings are discussed in terms of the practical difficulties regarding home-management by relatives of the schizophrenic.

Life-event data for a 3-month period were collected for 1058 adults. Six ways of categorizing life events and difficulties were analysed: namely, loss (L), threat (T), anti-social act (A), hopeless situation (H), uncertainty of outcome (U), and choice of action (C). Reliabilities were moderate to good. The number and the pattern of characteristics within a single event or difficulty were found to be the most important elements in predicting a depression score criterion. Two patterns were particularly predictive: CH present in an event or difficulty, and LH present with U absent. Approximately 21·9% of the depression score variance maybe explained using life events together with the respondent's social class, sex and social support. This represents a significant improvement over prediction based solely on the scoring methods of Brown & Harris (1978).

Cognitive functions of psychiatric patients with and without tardive dyskinesia were evaluated using the Wechsler Adult Intelligence Scale, Wechsler Memory Scale and Rey Auditory Verbal Learning Test. Schizophrenic patients with and without tardive dyskinesia did not differ in their performance on the administered psychological tests. However, affective disorder patients with tardive dyskinesia showed significantly more impairment on the Wechsler Memory Scale and Rey Auditory Verbal Learning Test than affective disorder patients without tardive dyskinesia. These findings suggest that affective disorder patients who develop tardive dyskinesia may have some predisposing brain damage or that tardive dyskinesia in these patients represents both a motor and a dementing disorder.

Classification and diagnosis are concepts of fundamental importance in medicine. Yet all too frequently in published papers the only measure of performance of a classification rule is the optimistic apparent error rate. This is defined, some real examples are given illustrating how poor it is as an estimate of true future performance, and alternative measures are suggested.

The Department of Psychiatry in its present form has developed since 1968, when the psychiatric branch of the Psychiatrische und Neurologische Klinik (Psychiatric and Neurological Clinic), the traditional type of a West German university hospital comprising psychiatry and neurology in one chair, became autonomous with the establishment of an independent chair of psychiatry. This was an early step in the separation of psychiatry and neurology, a situation which is now to be seen in all German universities. Moreover, during the last decade almost all psychiatric university departments have been more or less sub-divided into sub-specialities. This process has been carried to its furthest extreme in West Berlin which now has departments of clinical psychiatry, geronto-psychiatry, social psychiatry, psychosomatics, child and adolescent psychiatry, neuropsychopharmacology, psychophysiology, student mental health, and forensic psychiatry. The lines of demarcation have been drawn according to somewhat divergent (historical, personal, conceptual) criteria, so that the individual departments differ in size, research interests and research facilities. More than 10 professors, 15 senior doctors and about 50 assistants (physicians, psychologists, sociologists, mathematicians, chemists and engineers) make up a critical mass, but centrifugal forces are often dominant and restrain the optimal use of all facilities for real interdisciplinary collaboration in the sense of what has been described as the ‘agricultural’ approach to research (Shepherd, 1981).

Fifteen mentally retarded Swedish women, judged to be a representative sample, gave birth to 41 children. These children were followed up at the age of 1–21 years with regard to registrations in the Social Register, the Board for Provisions and Services to the Mentally Retarded and the files of the Child and Youth Psychiatric Departments. One child had died, and of the remaining 40 85% had or had exhibited severe psychosocial problems according to register data. The implications of the findings are discussed.

A comparison was made between the characteristics of patients admitted to the only psychiatric hospital in Newfoundland, Canada, and those admitted to general hospital psychiatric units within the same area. Patients were compared on demographic characteristics, diagnosis, incidence of violence and suicidal attempts, treatment, length of stay and previous admissions. The results suggest that patients admitted to the mental hospital are more likely to be single, male, of lower socio-economic status and to suffer from more chronic conditions. There is also a higher incidence of violence among patients admitted to the mental hospital. These findings have implications for the types of changes that will be required in general hospital units if the role of mental hospitals continues to decline.

The General Health Questionnaire (GHQ) was shown to be a valid instrument for the screening of psychological impairment in a defined population of Yugoslav students. Optimal indices of validity were obtained by the use of the 60-item version of the GHQ and a cut-off score of 13/14. The product-moment correlation coefficients between clinical ratings of severity of mental impairment and GHQ scores ranged from 0·71 to 0·78.

This is a preliminary investigation of admissions to a district general hospital psychiatric unit over a two-year period, in which patterns of psychiatric diagnoses in Jewish and non-Jewish patients were compared. Among the Jews there were significantly more patients with affective psychoses and fewer with schizophrenia than among the non-Jews. The methodological problems arising in such a study and some possible aetiological factors are discussed.

A study is reported in which smokers are shown to have higher psychoticism scores than non-smokers. This result is discussed in the context of the comments made by Eysenck (1983) on an earlier paper of ours (McManus & Weeks, 1982).

A cohort of 181 users of community psychiatric services in Camberwell with at least one year's history of contact was traced for two years following a census day. Four of the eight patients who had been given a primary diagnosis of an organic condition dicd during this period. For the others the population-standardized mortality risk was 2·4, similar to rates previously found for in-patients with acute disorders. The causes of death were those that are common in the population. Only one suicide was recorded.