Though there is evidence that the burdens which people face when they live with someone suffering from a functional pyschiatric illness have a considerable effect on both relatives and patients, very little is done in routine clinical practice to help in dealing with them. However, intervention with relatives is both practicable and effective, and sufficient is now known to indicate tentative guidelines for involving relatives in the management of patients by the psychiatric services. Strategies are suggested for dealing with problems of this sort which are faced by relatives.

The concept is discussed of how ego strength and equivalent dimensions of the term have been developed by well known contributors to psychotherapeutic literature and theory. A case is made for the translation of these dimensions, which include motivation and psychological mindedness, into operational terms and into items which are descriptive of the notion of personal and social competence. This has been done to provide guidelines for the assessment of patients for an optimal psychotherapy. A rationale for the inclusion for each item is constructed from the observations of experienced psychotherapists and research workers.

An investigation was conducted in the Aberdeen area on wives of oil men working either off-shore or on-shore. No differences were found in measures of general health; but ‘off-shore wives' were shown to experience mood and behavioural changes, linked to the pattern of swiftly recurring partings and reunions. While a majority of such wives appeared to tolerate or even thrive on their style of life, 10% had reactions sufficiently pronounced to deserve the label of Intermittent Husband Syndrome or ‘caseness'. Many others would have benefited from more effective preventive and support services.

Sustained attempts were made to identify all families in which there was a pattern of two or more generations of child maltreatment and multi-agency involvement in North-East Wiltshire (population 200,000) and where there were also two or more children maltreated in the current generation (born between 1960 and 1980). One hundred and forty-seven families were discovered. Disorders of behaviour of the parents of the 1960–1980 children are described. Collating information laboriously from at least 34 different agencies revealed very high levels of disturbance. Such detail was generally inaccessible, and its full significance for each family could only be assessed by using family medical record linkage methods. In the parents and antecedents, mental and personality disorders, suicidal attempts, mental handicap, dependence on drugs (mothers) or on alcohol (fathers), epilepsy and criminality were conspicuous features.

Two hundred and three male remanded prisoners were interviewed with respect to their current offence, mental state, and social and psychiatric histories. All but nine of the sub-group of 121 psychotic men showed active symptoms at the time of committing a criminal offence; 20% of the actively ill psychotics were directly driven to offend by their psychotic symptoms, and a further 26% probably so. If some of the indirect consequences of the psychosis were taken into account, 82% of their offences were probably attributable to the illness. Among the normal and neurotic men, none claimed psychotic motives for offending, but motives suggesting high emotional arousal such as panic or retaliation triggered the greatest violence. Within the psychotic group, those driven to offend by their delusions were most likely to have been seriously violent, and psychotic symptoms probably accounted directly for most of the very violent behaviour.

Progress in building and opening permanent and interim secure units between October 1982 and March 1984 was surveyed. Reasons for the delays in implementing the secure unit policy recommended in the 1975 Butler Report are described, and comparisons made between the different Regional Secure Unit (RSU) designs, staffing policies, and Regional Forensic Service models. The development of this Health Service innovation has now reached the stage where the limiting factor to further progress is not building but finding suitable staff and paying their salaries. The secure unit programme will highlight another group of underprivileged patients who will require further Health Service innovation.

A comparison was made of initial assessment, treatment, and pattern of care of two groups of non-psychotic patients, referred to a Central London psychiatric outpatient department. The patients, none of whom had been in recent psychiatric treatment, were differentiated into those receiving short-term care (less than one year) and those having long-term care (greater than one year). Chronic psychiatric disorders predominated in both groups. It was also common to have physical illness and contact with other hospital departments. Short-term care consisted of very brief contact for 70% of patients, and psychiatrists seemed unable to engage these referrals in treatment. Long-term attendance was associated with acutely ill young, or chronically ill older patients, more active initial intervention, and referral within the same hospital group. Follow-up revealed that long-term patients reported little symptomatic improvement, experienced considerable disruption in course of care, made increased demands on all aspects of psychiatric service, and often proved to have personality disturbance and social problems that were not perceived on initial contact. Types of intervention and their effects on other hospital departments were examined.

A sample of children and adolescents (n = 157) attending a child psychiatry outpatient clinic with conduct or emotional disturbance were compared with community controls (n = 76) for the number and type of recent life events. A Life Events Schedule for children and adolescents was developed and used as a semi-structured interview. Four clinical groups were identified according to their predominant presenting symptoms (conduct, mild mood, severe mood, or somatic). An excess of events carrying a severe degree of negative impact was found for all four groups, compared with matched controls. Eleven classes of events were examined: there is a suggestion that two classes (marital/family, accident/illness) may be more important for conduct and mild mood disorders, and that a further class (permanent separations, termed exits) may be more important for somatic and severe mood disorders.

This study examines the respective morbid risk for psychiatric illness determined by the family history method in the first-degree relatives of medical controls and patients with delusional disorder (paranoid psychosis) and schizophrenia. The morbid risk for schizophrenia and schizoid-schizotypal personality disorder was significantly greater in the relatives of the schizophrenic patients than in those of the delusional disorder or medical control patients, but no difference in the risk for affective illness or alcoholism was found in the three groups of relatives. Paranoid personality disorder was significantly more common in the relatives of the delusional disorder patients than in those of the medical controls. These results support the familial independence of delusional disorder and schizophrenia.

The use of the flash and pattern reversal visual evoked potential (VEP) in the diagnosis of primary presenile dementia was investigated. The results from 20 patients with primary presenile dementia were compared with those from a control group of normals of equivalent age and from a control group of 20 patients with cortical atrophy but no dementia. Presenile dementia caused a slowing of the major positive (P2) component of the VEP to flash stimulation. However, the VEP to pattern reversal stimulation (P100) was of normal latency. The difference between these two latencies characterises this unusual combination of results and is found to be a more specific diagnostic indicator of primary presenile dementia than the EEG or CT scan.

The records of all 53 clients who referred themselves to a community mental health centre in the first three years of its existence were studied retrospectively. These showed increasing and generally appropriate use of direct access for the relief of serious, often long-standing emotional distress. Self-referrals were much more often men than women, and some clients would probably not have been reached in any other way. The service seemed to reduce the local GPs' burden, at least subjectively. However, no-one presented with acute psychiatric disturbance or immediately impending breakdown. Any prevention achieved seems likely to be long-term rather than short-term.

Twenty patients with dementia were assessed by two raters, using the Standardised Psychiatric Interview of Goldberg et al (1970). Inter-rater reliability was good or fair for many items, but test–retest reliability and validity were less good. A single interview does not appear to provide a full picture of psychiatric (excluding cognitive) symptoms in demented patients.

Four sets of commonly used ‘operational definitions' of psychiatric disorders were applied to clinical information, obtained on the basis of semi-structured interviews with samples of hospital in-patients, out-patients, and general population. The agreement among them in defining ‘cases' and in assigning specific diagnostic categories was examined. There was considerable variation among the diagnostic systems in distinguishing between ‘cases' and ‘non-cases' and in identifying sub-groups of cases as having specific diagnoses. Comparison of operationally defined syndrome categories with diagnoses assigned by clinicians also showed much disagreement.

Hearing impairment and mental disorders are common among residents of nursing homes and homes for the aged; however, the relationship between sensory deficit and psychiatic illness has been little investigated in this population. The prevalence of hearing impairment, psychiatric illness, and co-morbidity was investigated in a sample of 102 elderly residents from consecutive admissions to a home for the aged. Examining the coincidence of these disorders showed evidence of an association between hearing loss and paraphrenia, and hearing loss and dysphoric states, but not between hearing and cognitive impairment. The results of this survey provide only suggestive evidence regarding aetiology, but strongly support conjoint assessment of the elderly.