This paper describes a psychogeriatric service in Gloucestershire. Agreement on policies was reached with general practitioners, Social Services, other psychiatrists and hospital nursing staff. The day hospital is regarded as the preferred area of treatment for a wide variety of patients, including the severely demented. In this service less than five per cent of admissions appear to become long-stay. With emphasis on day hospital and community support the number of beds for this type of patient recommended by DHSS may be excessive.

A study, covering the years 1964–67, of an integrated psychiatric service for a population of 92,000 was described in this Journal in 1969. This paper describes the continuation of this study to cover the further period 1967–75 and comments on data relating to the whole 11-year period. In this comment, the needs of this psychiatric service have been compared with data from other workers and with current Guidelines from the Department of Health and Social Security.

A validated objective measure of the state of psychological function was used to determine the incidence and course of psychological dysfunction in a group of evacuees from Darwin following disaster caused by a cyclone (Cyclone Tracy). While psychological dysfunction was increased initially (58 per cent) and at ten weeks (41 per cent), it had returned to an Australian general population control level (22 per cent) at 14 months.

Factors influencing psychological dysfunction were examined, and it is suggested that the sample faced two different stressors at differing times. Initial psychiatric morbidity was most clearly associated with the experience of thinking that one might die or be seriously injured and therefore conceptualized as a ‘mortality stressor’. Psychiatric morbidity at ten weeks appeared to be most closely associated with what has been conceptualized as a ‘relocation stressor’.

Reasons why psychiatric morbidity decreased to a general population control level are discussed.

Seventeen patients were treated by group desensitization and auto-hypnotic training over a period of six weeks for flight phobia, with a highly significant, reduction of fear for the group. Expectation of benefit correlated positively with fear reduction.

Ninety-eight matched pairs of patients treated respectively on first admission in a general hospital psychiatric unit or a psychiatric hospital have been followed-up for from five to eight years. The periods of treatment received in either setting remained comparable, and only 3 per cent of patients were in-patients or day patients at five years, while 14 per cent were out-patients and 20 per cent attended their family doctor. There was no evidence in these patients of a transfer of chronicity to the psychiatric hospital, but patients with longer periods of treatment were noted to change hospital from both the general hospital unit to the psychiatric hospital, and in the reverse direction.

Symptom and personality profiles of 33 agoraphobic women and their husbands are examined, revealing some evidence for assortative mating. The implications of this are discussed, and predictions are made about the changes required within a marriage in order to permit the effective symptomatic treatment of the female partner.

Animal experiments have demonstrated the likelihood that all known neuroleptics inhibit transmission in central CA-ergic systems, regardless of their chemical structure and via different mechanisms. For clinical psychiatry this fact prompts a number of questions: (1) is this phenomenon also to be found in human individuals; (2) if so, is it of importance for the clinical (side) effects of neuroleptics; (3) do patients with (schizophrenic) psychoses show signs of central CA-ergic hyperactivity ? This article presents a survey of clinical research focused on these questions which, for the sake of brevity, is confined to DA metabolism. The available data indicate the plausibility of a correlation between inhibition of DA-ergic transmission on the one hand, and on the other hand the therapeutic effects of neuroleptics and the occurrence of hypokinetic-rigid symptoms. The hypothesis that DA-ergic hyperactivity is an important pathogenetic mechanism in schizophrenic psychoses can be based only on indirect arguments; direct studies of the DA metabolism have so far failed to reveal supporting evidence. The possible causes of this failure are discussed.

In eleven patients with the syndrome of Capgras, the clinical data and the results of electroencephalographic, echoencephalographic, air-encephalographic, psychological and brain-scanning investigations are presented and discussed. All patients were psychotic: six were schizophrenic, four were depressive and one suffered from an organic psychosis. A paranoid element was marked in all cases.

The present evidence supports the view that organic factors are important in the pathogenesis of Capgras' syndrome.

The previous and subsequent convictions of all those charged with rape in 1961 were studied, together with circumstances of the criminal offence. The proportion of victims whose names were published in newspapers was high (26 per cent), and a high proportion of accused were acquitted (22 per cent). They fell fairly obviously into paedophiliac rapes of girls under 14 (30 per cent), ‘aggressive’ rapists (20 per cent) with a record of other aggressive offences, and ‘others' (50 per cent) with few if any other convictions. Various aspects of the records of these groups are considered. The paedophiles tended to have a wider age range and more often pleaded or were found guilty, and more of them received a medical disposal, rare in others. A small but similar proportion of acquitted and convicted were subsequently convicted of another rape.

The present policy of reducing the number of patients in hospitals for the mentally handicapped involves the discharge of many patients to residential care outside hospital. This paper considers 89 patients discharged from a hospital in the five years 1971–75. 64 (70%) went to facilities controlled by the Social Services Department, ten to other residential homes, eleven to lodgings and four to other institutions. Thirty five (40%) were subnormal (WAIS Full Scale IQ 55–69); the remainder, an unexpectedly high proportion, severely subnormal (WAIS Full Scale IQ, under 55). The majority of the patients discharged were the normal-looking mentally handicapped, few of whom had a specific cause for their condition. The suitability of patients for discharge in relation to the services available was more relevant than their ages or their years in hospital.

Seventy-eight psychiatric in-patients were allocated to personal illness classes by means of the Delusions-Symptoms-States Inventory (DSSI). Paper and pencil measures of psychomotor speed and scatter of tapping were administered with an immediate retest. It is suggested that from a social desirability position one would have to predict that the more personally ill (i.e. those endorsing the more socially undesirable items) would be slower and more diffuse on these measures. We found, however, such patients to be more constricted and slower. It is concluded that such a combination adds to the utility and validity of the hierarchy of classes of personal illness.

Haloperidol treatment for stuttering was examined in a double-blind cross-over study of 26 adult volunteers with long-standing stuttering. Most had had unsuccessful speech and drug therapy. During the three-month study, their speech and stuttering patterns were repeatedly evaluated from videotaped readings of a standard passage and during spontaneous speaking. Of the 18 patients completing the trial 11 were significantly more improved on haloperidol than on placebo, three benefited equally from both, and four were unchanged. Improvement over placebo was indicated by fewer dysfluencies, increased speed of speaking, and reduced secondary 'struggle’ phenomena. Side effects were common on a dosage of 3 mg haloperidol daily. Poor concentration, akathisia and dystonic movements caused 8 patients to discontinue the trial despite significant improvement in 5 of them. Although 'statistically significant’ improvement occurred in most patients on haloperidol, the ‘clinical significance’ of this form of therapy will be limited by the partial response, the need for continuous medication, the side effects of haloperidol and the attitude of stutterers to this type of therapy.

Home Office records were used to trace the current status of a sample of 128 persons for whom heroin was prescribed in 1969 at Drug Dependence Clinics in London. In October 1975, after a mean time since self-reported first use of heroin of 11 · 25 years, 51 per cent were attending clinics, 40 per cent alive and not attending, and 9 per cent dead. One third of the sample were still receiving heroin on prescription, and 23 per cent appeared to have received heroin without interruption since 1969. The report points to the need for career studies of addicts' lives and the need for follow-up interviews, especially for the 40 per cent no longer attending clinics.

Fifty-two patients thought to be suffering from dementia when first seen as neurological out-patients were fully investigated.

Four of them were found to have tumours, whilst in five the dementia was due to a treatable cause.

Neither a long history nor an age above sixty-five precludes a dementia being due to a treatable cause.

Abnormal EEGs have been reported in XYY and XXY men located in psychiatric hospitals and prisons. In general, persons resident in institutions are more likely to exhibit EEG abnormalities than ‘normal’ population, and this bias of ascertainment has complicated the interpretation of these results.

The present study was conducted in Denmark. Chromosome determinations were made on 4,140 men selected from a birth cohort of 31,438 men. Twelve XYY and 16 XXY men were detected. Appropriate XY control groups were selected from the same population. The XYY men were found to have a significantly lower average frequency of the occipital alpha activity than their controls. The XYY and XXY men showed significantly more theta activity than the controls.

How patients are seen by themselves and others close to them may influence the process of re-integration in the community after discharge. In a study in a psychiatric admission unit employing a therapeutic community approach, patients who sought little or no contact with the unit after discharge saw themselves, and were seen by others, as less ‘pleasant’ but less ‘ill’ than those who continued more regular contact. Perceptions were measured with the semantic differential technique. Patients' social class and household position were found to have a marked effect on the level of contact and on its association with how patients were seen. Diagnosis did not appear to influence hospital contact.

A case of folie à quatre is described affecting a proband and his wife, sister and brother. The three family members retained their symptoms of paranoid schizophrenia. The wife was not mentally ill and her delusions disappeared in time (folie imposée). Coincidentally, there were several cases of Huntington's chorea amongst her relatives. Different categories of folie à deux are demonstrated in the various family members and relationships.

We report for the first time the case of a male patient with the Noonan syndrome (Turner phenotype with a normal karyotype) who also had a psychiatric disorder which satisfied research criteria for schizophrenia.

Questionnaire replies from 43 experienced psychiatrists showed wide variation in the ways they would manage a common type of neurotic problem. There were considerable differences in the nature and duration of treatment and in the use of other members of the psychiatric team. The conclusions have implications for training and for the use of health care resources.

This preliminary study investigates the effect on patients' performance of a set time off, in the form of a short holiday, from a strict reinforcement (token economy) regime.

Assessment was by the patients' mean token earnings before and after the holiday and their self-care and work performance throughout. The results suggest that a holiday from a token economy has beneficial effects for patients.