The well-developed community psychiatric services in the 13th Arrondissement use a large number of places in sheltered accommodation. Reasons for this are explored. It may be that there are areas in the U.K. where the need for such accommodation is greater than the Department of Health and Social Security has estimated.

The point prevalence of tardive dyskinesia (TD) as assessed by means of the Simpson rating scale was determined for 14 psychiatric wards with 347 patients (213 and 134 female) at the time of the study. TD was found to occur in 17.3 per cent of the patients, the prevalence being significantly higher in female than in male patients. The frequency of TD increases with age.

A random group of TD patients was matched with a group of patients without TD and the total medication for both groups was calculated. No differences were found as concerns total amount of high or low dosage neuroleptics, or anticholinergic drugs, for the two groups. However, significantly more TD patients than controls had received dosage neuroleptics, or anticholinergic drugs for the two groups. However significantly more TD patients than controls had received anticholinergic drugs.

There was no significant relationship between severity of TD: age, duration of treatment, total amount of high or low dosage neuroleptics. On the other hand a significant relationship was found between severity of TD and amount of anticholinergic drugs. Significantly more patients in the TD-group than in the control group had a past history which might suggest possible brain damage prior to the neuroleptic medication.

The labelling theory of mental illness and particularly that version formulated by Thomas Scheff has been applied to psychiatry. Studies completed by Scheff have produced considerable evidence to support labelling theory. An attempt is made here to determine to what extent labelling theory applies to a group of British psychiatrists. The results give little support to Scheff's position.

A cross-sectional study was performed on 66 lithium-treated patients to investigate a possibly changed kidney function, using [51Cr]-EDTA clearance, and urinary excretions of albumin and β2-microglobulin. Thirteen patients showed abnormal test results: seven had decreased glomerular filtration rate, four had increased albumin excretion and four had increased excretion of β2-microglobulin. There was no correlation between length of treatment with lithium or hypothyroidism (10 patients) and impaired renal function. Four patients had already manifested signs of renal dysfunction before lithium treatment. The high prevalence of impaired renal function among our patients is unexplained but lithium could be one possible cause.

The progress of 52 chronic alcoholic habitual drunken offenders who were offered a detoxification, assessment and referral service as an alternative to penal management for their public drunkenness was compared over a year with 48 control subjects, and each group's progress in the experimental year was compared with that in the previous year. The ‘detoxification’ patients were found not to have benefited as regards their alcoholism or episodes of drunkenness, though their periods of abstinence were longer. There were significant improvements in their accommodation and self-reported quality of life, and it is likely that their physical and perhaps mental health improved.

This paper concerns a new clinical role for psychiatric nurses—as case managers for selected adult neurotics with behaviour problems. The role involves unusual autonomy. The selection and training procedures are unusually rigorous and focus on general case-management as much as behavioural skills. The number of service posts offered these therapists is rising. These developments have wide implications for other personnel, particularly in respect of authority and responsibility boundaries, selection and training procedures, and team structure.

Schneider's typology of the personality disorders is described briefly. Three psychiatrists made diagnoses on two sets of patients, both of which contained one example of each type. The diagnoses were made with the help of a glossary and based upon the examination of clinical summaries and audio-recordings.

Values of two reliability coefficients showed considerable variation between types. High reliability was found for Schneider's asthenic, explosive, depressive and affectionless types. Low reliability was found for the fanatic, labile and hyperthymic types. The insecure and attention-seeking types were overused. Some possible causes of this variation are discussed.

Twenty former male patients who in childhood had been diagnosed as having schizoid personality were followed up in adulthood. In comparison with controls, they used psychological ways of construing infrequently. Interpretations of this finding are discussed, in particular its relationship to impaired empathy.

Ninety-two children who had been examined in a psychiatric study of five to twelve year-olds in long-term residential care were followed up four years later. Three-quarters were still in children's homes, but over half had been moved to different establishments. At both the original study and follow-up, the majority showed evidence of psychiatric disorder. Considerable continuity of behavioural pattern was found, particularly amongst those who originally had antisocial disorders, who were also most likely to have had changes of care-taker during the four years. It is suggested that the persistence of their disorder may be due to a vicious circle of unacceptable behaviour and adult rejection.

Fifty-seven patients with a diagnosis of schizophrenia were started on either fluphenazine decanoate or flupenthixol decanoate injections in a double-blind trial just prior to discharge into the community. During the six month follow-up 30 per cent dropped out of the treatment. Of those observed for six months, 7 per cent relapsed, 54 per cent experienced depressive symptoms and 88 per cent extrapyramidal side-effects. Analysis of both clinical data and the ratings failed to discriminate between the two drugs.

Two patient samples, with different criteria for selection, have been surveyed following maintenance therapy discontinuation. The patients had previously remained in a steady mental state on depot injections for periods varying between one and four years. Both the rates of relapse and pattern of relapse suggest that patients responding to medication need to remain on maintenance therapy for a minimum of four years. The results further suggest that in chronic schizophrenia the drugs only suppress symptoms and that the prognosis following discontinuation is substantially unchanged by increased duration of medication, even after four years. The possibility of using short-term ‘drug holidays’ to reduce the risk of unwanted effects was explored; after only three months without drugs, the risks of relapse were significantly increased.

In an attempt to demonstrate a valid boundary between schizophrenia and the affective psychoses, discriminant function analyses have been carried out with history, mental state and follow-up data in two populations of patients. A bimodal distribution of discriminant scores was obtained in one of them (a general psychotic sample of 128 patients), using a discriminant function derived from the same sample; but when the function was applied to the second population (a schizoaffective sample of 106 patients) the distribution was ambiguous. Functions derived from the schizoaffective sample produced highly skewed distributions of discriminant scores in the general psychotic sample.

Kraepelin's hypothesis that the functional psychoses consist of two distinct disease entities receives some support from our findings, but there is still no compelling evidence that the universe of psychotic patients falls naturally into these two groups.

In view of the previous finding that female deluded depressed patients do not respond to tricyclic antidepressants, a retrospective review of charts of thirteen male patients with primary depression accompanied by delusions was undertaken. None improved on tricyclics alone, whereas all those treated initially with neuroleptics improved. Twelve out of thirteen patients showed no improvement until neuroleptics were added to the treatment regimen. Implications for classification and treatment are discussed.

Treatment in a psychiatric unit, as distinct from a psychiatric hospital, held no benefits in the long term (5–8 years after admission) as far as the patient's mental and behavioural status and employment, or the family's burdens, health needs or attitude were concerned. Schizophrenic patients from both settings received more hospital treatment and medication, were more often unemployed, and had more adverse effect on relatives' health than neurotic or depressive patients. Hospital attendence identified relatives who expressed a need for support.

The ‘Coping With Drinking’ questionnaire, administered to 124 A1-anon members, was factor analyzed and revealed nine identifiable styles of coping. Multiple regression analyses between three measures of sobriety and each of the nine styles of coping factors provide support for the general hypothesis that the coping styles used by wives of alcoholics are related to drinking outcome. Further, those modes of coping in which the wife communicates her feelings of distress and frustration to the drinking husband in a way which is minimally threatening for him seem to be most positively related to his attainment of sobriety.

Every article published in the British Journal of Psychiatry between 1945 and 1974 was reviewed that provided original information derived from the direct assessment of long-stay patients. The 225 articles were examined for details of assessment practice and characteristics of the patients studied. Most studies used a very restricted range of assessment methods, with rating scales, used most frequently. Many used wholly unstandardized methods, and the description of patient characteristics was inadequate. A number of improvements in assessment practice are suggested.

One hundred and fifty four patients admitted to a general hospital psychiatric unit with a history of poor diet were examined. Serum pyruvate was estimated in all, red cell transketolase in 74 and red cell aspartate transaminase in 66. Significantly more of the 58 abnormally low thiamine patients than of the normal thiamine group showed clinical signs of malnutrition or were diagnosed as chronic alcoholics, drug addicts, schizophrenics or endogenous depressives. Significantly more endogenous depressives than other patients had a raised aspartate transaminase activity coefficient (pyridoxine lack.) While most low thiamine findings are probably manifestations of malnutrition pyridoxine lack may have some aetiological significance in endogenous depression.

A limited study into the accuracy of information for the Mental Health Enquiry was undertaken at two major mental illness hospitals in Leicestershire. The results indicate that certain items of data are of questionable value. The current arrangements for processing the data may also need review.

The authors attempt to integrate several psychoanalytical and more recent neurobiological concepts regarding the development of the organism and emergence of psychopathology. They highlight the rough temporal correspondence of neurodevelopmental myelination cycles with stages of psychosocial development. They discuss concepts of critical periods and unique times of vulnerability to psychosocial insult and recurrence of critical stresses, gleaned from a multidisciplinary point of view, in relation to the occurrence of psychic aberrations. They suggest that it may be fruitful to explore further psychological constructs such as fixation and regression, as well as unconscious mental processes, in relation to their biochemical, physiological, and anatomical representations in the brain.

The post-war development of psychiatric services in Nottingham, with their reduction in the number of beds and marked increase in in-patient turnover and day patient and out-patient attendances, represents a close approximation to the proposals of the 1962 Hospital Plan. These changes were achieved by redeployment of existing resources.

A fifteen-year attrition study of 1960 long-stay in-patients shows a high rate of discharge, especially for males.

The reasons for these findings and some implications are discussed.