The types of problems of 49 patients referred to a psychiatrist in a terminal care unit are reported and their management reviewed. The findings suggest that a psychiatrist can play a useful role in such a unit, particularly in supervising medical and nursing staff in the psychological care of patients and in helping more directly in the management of psychiatrically complicated cases.

The psychotherapeutic aspects of the care of the 49 terminally ill patients described in the preceding paper are discussed. Their differing ways of coping with the stress of dying and the range of psychotherapeutic strategies used in treatment are described. The work suggests that the therapist's use of psychological insights can improve his understanding of the emotional pain of terminal illness, and well-aimed psychotherapy can contribute to its relief.

The case notes of all 67 manic patients admitted to the psychiatric wing of a District General Hospital over a period of two years were screened for evidence of independent life events during a four week period prior to admission. The nature of such events and of the underlying stresses was examined and the data obtained were compared with data from a control group of acute surgical admissions. Four times as many manic patients had an independent life event closely preceding their admission. It is concluded that stress in the form of loss or threat is a common precipitant of mania. Some surprising findings are focused upon and discussed.

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.

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 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.

The enquiry relates to the investigation of 30 cases of obsessive-compulsive neurosis with special reference to the phenomena of hostility and guilt as revealed through Foulds' Five Punitive Scales and the Thematic Apperception Test. Controls consisted of an equal number of subjects suffering from neurotic depression. Analysis reveals acting-out hostility and extrapunitive tendency in the experimental group. No significant difference was found in terms of guilt scores.

Small but statistically significant increases in serum total calcium and serum inorganic phosphorus coincided with repeated onsets of psychotic agitation or mania in nine psychotic in-patients experiencing rapid cycles of illness. These increases were not accompanied by changes in magnesium or other constituents, which might suggest non-specific haemoconcentration. Similar increases in calcium or phosphorus were not present in patients without the same cycles of psychotic illness. The observed increases could neither be simulated nor altered by stress or activity, and it remains unclear whether they might be accounted for by dietary changes, sleep disruption, circadian phase shifts or by endocrine alterations.

Motor activity, monitored by a wrist motion transducer, was related to serum CPK activity the following morning in a group of psychiatric in-patients. In 4 of 10 patients, studied for periods exceeding one week, total 24-hour activity was significantly correlated with morning serum CPK activity. Motor activity during the night was unrelated to serum CPK activity. In a larger group of 30 patients, studied for one or two-day periods, inter-individual differences in activity level were not related to serum CPK activity, although both sex and race were significantly related to variance between subjects in that activity.

This is a study of the results of screening tests on all new psychiatric in-patients over a period of one year. Although none of the results indicated definite physical causes for the psychiatric illness, 10 per cent of the tests revealed abnormalities resulting from or co-incidental with the psychiatric illness. Of these abnormal results 61 per cent led to no further investigation or treatment, and the significance of this is discussed.

Three groups of neurotic depressed patients were treated with amitriptyline, one group receiving the customary three daily doses, another a single dose in the morning, and the third a single dose at night. All three groups showed significant decrements of total scores on the Hamilton Scale for Depression and the Zung Self-Rating Depression Scale without significant differences. Patients taking the drug at night showed a lower incidence of side effects.

There is evidence that ECT causes a breakdown of the blood-brain barrier through the rise of blood pressure it induces. Using the Benton test of cognitive function the day before and three hours after ECT treatment in 27 depressed patients, impairment of function was highly correlated with the maximum rise of systolic BP during the treatment.

This case report describes a young man with a 47, XYY karyotype who was convicted of arson. He suffered from a cardiac disorder which may well have been part of the XYY syndrome rather than a chance association. His abnormal karyotype was disclosed in court and used by the defence in a plea in mitigation.