Deinstitutionalisation is a two-part process: the first involves discharging patients from hospital to the community, which has been done in many countries. The second part—the provision of adequate resources for good community care—has still to materialise almost everywhere. In New South Wales, the inpatient mental hospital population dropped by two-thirds in 20 years, yet the total number of hospital staff increased considerably during this time; on the other hand, in the community, where most of the patients are, there are relatively few staff. This has important consequences: it means that for many patients, their episode of illness has to progress unchecked until it is of sufficient severity for them to be admitted to hospital. When that happens, there will then be enough staff to give them good quality care, so that their symptoms can subside, but afterwards there will again be hardly anyone available to help maintain them and to prevent relapse.

Belief in witchcraft, which serves a variety of social functions and personal defences, is bound to emerge in psychotherapy with individuals from a culture that holds such beliefs; endeavouring to understand it can open up new therapeutic possibilities. The nature of witchcraft, the profiles with which it intrudes into therapy, and the socio-psychological functions it fulfills are considered. Referring such patients to witchdoctors is morally unjustifiable, but the witch-doctor's folk-image provides a floating transference, around which the therapeutic relationship can be built. In dealing with witchcraft-ideation, understanding is based as much on cultural as on personal empathy, and to enhance its relevance, therapy may appropriate some of the functional dynamics of the witchcraft system into its own therapeutic manoeuvres.

Data were collected, using interviews with parents and teachers and rating scales, concerning the behaviour of two groups of mentally retarded children: 193 children with Down's Syndrome (DS) and 154 children with a similar degree of handicap were identified in the same schools. The proportions of children who had high scores on the Rutter or an additional behaviour check list, were similar in the two groups. Deviant behaviour was markedly more common in both sets of retarded children than in their siblings next in age; 31% of the children with DS and 29% of controls were judged to be well adjusted, while 38% of the DS children and 49% of the controls had significant behaviour disorder. Conduct disorders were most common in the children with DS. ‘Psychosis' was the most common diagnostic label in the control group, but was also found in the children with DS.

The families of Down's Syndrome children and another group with a similar degree of retardation were compared using data collected at interview. Differences in social class distribution were explained by the maternal age effect in the Down's group. Divorce was more common in the control group but the quality of marriage in those parents still together and the health of parents were similar. No close associations were found between behaviour disorders in the children and family factors, except that behaviour disorders were likely to be associated with similar disturbance in siblings next in age and to be more common in the less happy marriages.

There have been many reports of psychiatric disorder in medical populations, but few have used standard methods on representative patient groups. Even so, there is consistent evidence for considerable psychiatric morbidity in in-patient, out-patient and casualty department populations, much of which is unrecognised by hospital doctors. We require a better classification of psychiatric disorder in the general hospital, improved research measures, and more evidence about the nature and course of the many different types of problem so that we can provide precise advice for their management of routine clinical practice.

Few biological theories of manic-depressive illness have focused on the longitudinal course of affective dysfunction and the mechanisms underlying its often recurrent and progressive course. The authors discuss two models for the development of progressive behavioural dysfunction—behavioural sensitisation and electrophysiological kindling—as they provide clues to important clinical and biological variables relevant to sensitisation in affective illness. The role of environmental context and conditioning in mediating behavioural and biochemical aspects of this sensitisation is emphasised. The sensitisation models provide a conceptual approach to previously inexplicable clinical phenomena in the longitudinal course of affective illness and may provide a bridge between psychoanalytic/psychosocial and neurobiological formulations of manic-depressive illness.

A new dichotic listening test (fused rhymed words) was used to monitor changes in perceptual asymmetry (PA) in patients recovering from acute psychotic episodes; some were also given a dichotic nonsense syllables test, a dichotic tone test, and a single visual field dot localisation test. Contrary to expectation, PA on the word test decreased with recovery, while asymmetry on the tone and dot tests did not change; results cut across diagnosis, could not be related to medication, and were independent of changes in overall performance. More specific hypotheses are needed than those of generalised single hemisphere dysfunction in major psychiatric illness, but existing models and concepts are inadequate to explain the findings.

Intracavernosal injection of phenoxybenzamine or papaverine has been tried on 127 men suffering from erectile impotence. In 113 of them it caused an erection which should have sufficed for coitus. Seventy-three men have used such injections, given at home by themselves or their wives, fortnightly or less often, to make coitus possible after each injection; 54 of them still do so.

The presence of tardive dyskinesia in a sample of 43 patients with schizophrenia and 37 psychopaths who had been hospitalised for many years and exposed to large amounts of medication was assessed while testing their cognitive function. Subjects who showed no evidence of abnormal movements performed significantly better on the test of delayed recall, but there were no differences in performance on any of the other tests of cognitive function used. Multiple regression analysis revealed that age and the total lifetime dose of neuroleptic medication received (in chlorpromazine equivalents) were the only variables to predict the Abnormal Involuntary Movement Scale score, although a large amount of variance in this variable was unaccounted for. The duration of treatment with neuroleptics did not predict AIMS score.

Zinc deficiency has been reported in association with dementia and linked with its pathogenesis. A group of 45 elderly patients admitted to a mental hospital were given diagnoses in accordance with ICD-9, and their fasting plasma zinc levels were recorded. No difference was found in zinc levels between patients with diagnoses of senile dementia and those with other diagnoses.

In a prospective study of the 295 admissions in one year to an acute psychiatric ward, 14 subjects without delirium or dementia were found to have developed temporary urinary incontinence. When compared with matched controls (n = 56) the incontinent patients were found to be suffering from psychosis (P < 0.0002) and to have a history of childhood enuresis (P < 0.01). Compared with psychotic controls (n = 22), the incontinent patients were older (P < 0.05), they had been exposed to a greater variety of treatments (P < 0.01), and they had received more thioridazine (P < 0.04).

In an investigation of white, coloured, and black patients admitted to a psychiatric hospital, the prevalence and treatment of depression in schizophrenia was assessed and found to be 30% in group of acute, nuclear schizophrenics. While the prevalence was similar in the three groups, depression was clinically under-detected in black patients.

The correlations between eye movements on the EOG of a patient with a 48 hour cycle of manic-depressive type are described. They are used to confirm the fact that his switch from one state to another occurred at the same time of night whether he was awake or asleep.

A retrospective analysis of the violent incident forms returned over a one year period in a psychiatric hospital recorded 283 incidents involving 144 patients. Almost all were of a petty nature, none leading to lasting injuries. Compared with the average daily in-patient population, offending patients were more likely to be male, to be less than 45 years old, and to have a diagnosis of schizophrenia.

Psychological and drug-related variables and their effect on the severity of withdrawal symptoms were examined in a group of addicts being withdrawn from opiates on an in-patient drug dependence unit. Two psychological factors—neuroticism and the degree of distress expected by the patient—were related to subsequent severity of symptoms. Both are anxiety-related, and may serve to amplify withdrawal symptoms. Surprisingly, drug dose was unrelated to symptom severity.

The clinical and biochemical disturbances of a patient with seasonal hypomania and cold urticaria are described and discussed with reference to histamine metabolism in mental disorder.

Priapism is a rare but serious adverse effect of psychotropic drugs resulting from their peripheral alpha-adrenoreceptor blocking action. Two patients developed this during treatment with oral phenothiazines: one was treated surgically with a venous shunt, and the second case resolved after intracavernosal injection of an alpha-adrenoreceptor stimulating drug.