The historical development of official provision for the care and training of the mentally handicapped—both adults and children—is outlined, to show the changes between Local Authority and Government. Changes in emphasis between compulsory and voluntary admissions to institutions are discussed with particular reference to changes in the law and the administration of the services. Demographic changes due to longer survival, falling birth rate, and prevention, diagnosis and treatment of individual causes of mental handicap are discussed. Particular reference is made to Down's syndrome and to the fragile X syndrome.

The need for psychiatrists in mental handicap is mentioned along with the benefit of early intervention. The numbers of the mentally handicapped needing specialist care and training are not diminishing, but the manner of provision is changing, and partly reverting to ways tried long ago.

The experience of 82 demented female patients, admitted to Crichton Royal in the period 1957–59, is compared with 107 similar female patients from 1974–76. All finally died in the hospital, or at the closure of the study in November 1981 were long-stay patients there. Results show that on average, each patient in the more recent group spent 24 per cent longer in hospital; the results, however, were only statistically significant in the very elderly—over 85. Further study of the 1970s failed to demonstrate that day care and intermittent holiday admissions had any effect on the length of time the patient spent in hospital on final admission. Using the study data, models of future needs are worked out on the basis of bed requirements for patients admitted without prospect of discharge.

The diagnosis of hyperkinetic syndrome is rarely used in the UK, in marked contrast to its counterpart in the USA. Most of the work on hyperkinesis is concerned with the North American concept and relatively little attention has been paid to the British approach. The present paper reviews the development of the UK concept and diagnosis, describes the characteristics of 73 hyperkinetic syndrome children seen at the Bethlem and Maudsley Hospitals over 13 years and compares them to matched psychiatric controls diagnosed as conduct disordered. Results indicate that the two groups are differentiated by a number of symptomatic and clinical features, with the conduct disorder group showing a greater frequency of aggressive, antisocial, emotional and psychosocial disturbance which contrasts with higher frequencies of motor disturbance, inattentive and articulatory disturbance in the hyperkinetic group. No differences were found between the groups in brain pathology or sensory handicap. The findings provide support, at least in terms of symptoms and clinical features, for the concept and diagnosis of hyperkinetic syndrome (ICD 9).

The strategy of high-dose intramuscular haloperidol as routinely applied in a general hospital psychiatric ward to 74 successive patients, 33 of whom stayed only up to seven days, and a further 34 up to 15 days, led to a complete recovery in only six, and complete lack of change in 23. Adverse reactions were recorded in 42, severe enough to stop treatment in eight; there were three deaths. In view of this risk-benefit analysis, systematic application of this high dose strategy to get a more rapid turnover of patients is unjustified.

Two hundred and eleven women between the ages of 18 and 65 years referred to a gynaecological out-patient clinic were screened for psychiatric disorder using the General Health Questionnaire (GHQ) and a Demographic Questionnaire. A random sub-sample of 35 women were interviewed using the Present State Examination (PSE) and the Brown and Harris Life Events and Difficulties Schedule (LEDS), and compared to a general population sample (N = 140) matched for life stage (LS) and social class. Forty six per cent of women in the clinic scored as cases on the GHQ. High scores were associated with being divorced, separated, or widowed, and with complaints of pelvic pain. PSE case rates were higher in the clinic sample than in the general population group (29 per cent and 17 per cent). Younger women (LS 1) and middle class women in the clinic sample had higher rates than in the general population. Only the middle class women in the clinic sample showed significantly higher rates for severely threatening life events and/or difficulties before onset of psychiatric disorder. The study supports the view that rates of psychiatric disorder are high among women referred to a gynaecology clinic and indicates the importance of associations with demographic factors and recent experience of life stress, especially marital difficulties.

A group of first-time mothers (119) were interviewed repeatedly at fixed intervals during their pregnancies and until their babies were a year old; they were then followed up at four years. A similar investigation was carried out on 38 other primiparae and 39 multiparae, but only postnatally.

The incidence of depressive neurosis rose significantly in early pregnancy and in the first three months after delivery (10 per cent and 14 per cent of the main sample respectively). Subjects mainly suffered either from antenatal or postnatal depression, not both. Marital conflict and severe doubts about having the baby were associated with depression at either time. Bereavement and preterm birth were the only life events to relate with the onset of depression and bereavement had a greater impact during pregnancy.

Depressed mothers were more likely to express negative or mixed feelings about their three-month-old babies. Many who had become depressed for the first time in their lives continued to experience psychological problems for up to four years after childbirth.

In a double-blind placebo controlled trial of oxypertine in the treatment of tardive dyskinesia, 33 patients with chronic schizophrenia received either oxypertine or placebo. At the end of eight weeks, the results showed that oxypertine was superior to placebo at a statistically significant level.

Sixty alcoholics (40 males) were assessed for agoraphobia and social phobia, and over half the sample were rated as having either or both these disorders when last drinking. Twenty one subjects had mild phobias and eleven had severe phobias. The more severely phobic males were also found to be the most alcohol dependent and those with no phobias were least alcohol dependent but this effect was not found among the females. All phobic alcoholics reported that alcohol had helped them to cope in feared situations, and almost all had deliberately used it for this purpose.

A small sample of out-patients referred for phobias alone were also asked about their use of alcohol. The majority had found it helpful in coping with fears, although more men than women had deliberately used it for this purpose.

Twenty-four hospitalised problem drinkers who were currently suffering from a phobic anxiety state served as subjects for this study. Each was given a detailed retrospective interview concerned with the development over time of both their alcohol dependence and phobic problems. The test-retest and inter-rater reliabilities of the data collected were found to be high. In accordance with previous experimental work, periods of heavy drinking and dependence upon alcohol were associated with an exacerbation of agoraphobia and social phobias. Subsequent periods of abstinence were associated with substantial improvements in these phobic anxiety states. It is suggested that both learning and psychobiological processes underly these observed relationships and that the implications of this finding for treatment of both disorders should be explored.

The authors have previously reported that a sub-group of schizophrenic-like patients respond favorably to lithium therapy: furthermore, psychotic patients who respond to lithium demonstrate appreciable improvement during the first seven days of treatment. The present study investigated which symptoms of schizophrenia improved quickly during lithium treatment. We found that patients who do respond to lithium show significant improvement in the core symptoms of psychosis—hallucinations, delusions and formal thought disorder—during the first seven days of treatment, thus allowing early identification of 88 per cent of schizophrenic patients who ultimately respond to lithium and 91 per cent of those who do not.

We identified the population of schizophrenic patients under 65 in a geographically defined area. The number using psychiatric services based on a new District General Hospital unit in the course of one year was 364, a prevalence of 2.2 per 1000 adult population. Half the patients lived in supportive private households, most often with spouses or mothers. More women than men married and retained supporters. Patients and their primary supporters were interviewed separately. The PSE Catego programme classed 47 per cent of patients as psychotic. Supporters reported disturbed behaviour in 65 per cent of patients, and restricted social performance in 78 per cent. There was evidence of hardship (emotional and physical ill-health, problems with children) in 90 per cent of households. Supporters' subjective distress was directly related to the presence of psychosis and disturbed behaviour and inversely related to the duration of the illness. Drop-out and failure to take medication appeared to be causes of the relatively high prevalence of psychosis.

Current psychiatric classifications of anxiety are examined critically. In the European literature a specific cluster of symptoms is diagnostic of anxiety neurosis and their subsidiary classification is based on precipitating factors and duration of symptoms. In the American literature, exemplified by DSM-III, greater emphasis is placed on symptomatic classification and panic is given separate diagnostic status, both alone and in conjunction with agoraphobia. In both classifications generalized anxiety is at the bottom of a diagnostic hierarchy so that all other symptoms take precedence. It is argued that neither classification properly identifies a discrete syndrome of pathological anxiety that is recognizable in clinical practice.

With the help of data on the registered days of sickness per year, a study was made of a group of relatives (n = 32) who had suffered sudden and unexpected bereavement to determine whether this resulted in an increase in morbidity in the two-year period following the loss, compared with the previous two years. A comparison was made with a control group of relatives who had also suffered bereavement but where the deaths were not unexpected. Increased morbidity, especially psychiatric morbidity, was found following sudden and unexpected bereavement but not in the control group. It is concluded that persons exposed to sudden and unexpected loss of a close relative are subject to increased psychiatric morbidity and should be regarded as a high-risk group.

In a group of schizophrenics of twin birth, no evidence of ventricular enlargement was found where there was a family history of major psychiatric disorder. Among those schizophrenics without such a family history, cerebral ventricular size was significantly increased (P <0.01), and there was also evidence of birth complications. Among normal control twins, those who reported complicated births had significantly larger ventricles.

Adolescence is a stage in the development of an individual which links childhood and adult life. Nowadays in Western society adolescence lasts from the early teens, about the time that puberty normally begins, until the early twenties. The main feature of this period is the adoption of adult ways of behaving. There are a number of obvious milestones, the end of compulsory education in the mid-teens and the start of work or further education, the possibility of living independently away from the family and of marriage, as well as the right to drive a car and to vote. Adolescence is accompanied by accelerated physical growth, the development of secondary sexual characteristics, increased emotional maturity, the emergence of a new way of thinking and the formation of a particular identity. A glance at Boorer and Murgatroyd's selected bibliography published in 1972 and the list of references in Rutter's Rock Carling Fellowship Monograph: Changing Youth in a Changing Society (1979) shows the enormous number of books and papers which have been devoted to this period of life. For anyone wanting a readable introduction to the subject of Adolescence, the two relevant chapters of Mussen, Conger and Kagen's (1974) Child Development and Personality can be confidently recommended.