These documents were prepared by Dr J. A. Baldwin, Dr J. Leff and Professor J. K. Wing at the request of the Executive Committee of the Social and Community Psychiatry Group of the College. After extensive consultation they were approved by the Executive and Finance Committee as representing the policy of the Royal College of Psychiatrists.

Copies of the Code of Practice (Annex B), and of the unpublished Annex C, Technical Arrangements for Ensuring Confidentiality and Annex D, General Features of Medical Information Systems, are obtainable from Professor J. K. Wing, M.R.C. Social Psychiatry Unit, Institute of Psychiatry, De Crespigny Park, London SE5 8AF.

The subjects of this study were eighty misusers of heroin who lived in the New Town of Crawley, West Sussex. The relationship between their criminal histories and their histories of drug misuse were examined. It was found that more of the heroin misusers than would be expected had been convicted of criminal offences before they began to misuse drugs, while the reduction or cessation of heroin use during a four-year follow-up period was accompanied by a reduction in convictions. Some social characteristics of the male heroin misusers were compared with those of two other Crawley groups—a group of juvenile offenders who did not misuse heroin and their control group of non-delinquents. Characteristics commonly associated with maladjustment did not distinguish the heroin misusers from the juvenile offenders, nor were they found to be associated with the continued use of heroin. Analysis of the data in epidemiological terms suggested that among the necessary conditions for an outbreak of drug misuse in a particular community the availability of drugs together with socializing drug users were more important than the presence of predisposed individuals.

Six cases of Gilles de la Tourette's syndrome are discussed in the light of conflicting views on the aetiology of the condition. It is hypothesized that the onset of coprolalia in patients with persistent childhood tics indicates a disturbance of the normal balance between a need for tension relief by swearing and a capacity to control such vocal activity. Some conclusions are drawn on the management of the syndrome by the use of butyrophenones, massed practice of tics, and the promotion of personality development. A flexible approach geared to the individual patient's particular needs is recommended.

Some conclusions are drawn on the management of the syndrome by the use of butyrophenones, massed practice of tics, and the promotion of personality development. A flexible approach geared to the individual patient's particular needs is recommended.

Four patients with systemic lupus erythematosus (SLE) are described in whom there were major psychiatric complications. Two of these patients had cerebral lupus with psychiatric manifestations of the disease together with other features of disease activity and responding to treatment with high dose steroids. The first of these had had a ten-year history of recurrent episodes of depression before other features of the disease became evident; in the second patient recurrent psychotic episodes occurred after the onset of typical multi-system disease. The third patient had had a minor cerebro-vascular accident four years before other features of SLE became manifest, and cerebral deterioration later on in her life was probably due to hypertensive cerebro-vascular disease secondary to the renal disease of SLE. The fourth patient, a young man, had had recurrent episodes of depression and aggressive behaviour for several years and committed suicide at the age of 33.

We investigated the psychological status of Crohn's disease patients because 10 such patients had been referred to our psychiatric out-patient department over a period of six years, whereas if there were no association between the disease and psychiatric morbidity, the expected referral rate would be one case in 20 to 100 years. We found an association between episodes of psychiatric and physical symptoms in the case histories. We administered the Eysenck Personality Inventory and the Manifest Anxiety Scale to 28 out-patients with Crohn's disease (8 psychiatrically and 20 non-psychiatrically referred), 17 with chronic non-psychosomatic medical diseases, 43 with psychosomatic diseases and 100 with neurosis. Crohn's disease patients were significantly more anxious, neurotic and introverted than both the test norms and the non-psychosomatic medical out-patients and did not differ appreciably from the psychosomatic patients in these respects.

Phenothiazine drugs were withdrawn from 17 chronic schizophrenic in-patients, with a control group of 14 patients remaining on active medication. The trial was conducted under double blind conditions over a period of 42 weeks with weekly assessment of the patients by ward nurses. Of the placebo group 35 per cent relapsed, relapse being related to the level of previous active medication.

This study attempted to clarify the nature of dysfunction in the selective attention of schizophrenics. Within the framework of Broadbent's (1971) theory of information processing it was argued that ‘filtering’ inefficiency should be reflected in a reduction in the discrepancy in performance on a short-term memory task between the condition of pre-instruction as to the relevant material and that of post-instruction. Three groups of subjects, 10 schizophrenics, 10 depressives, and 10 normals, matched for age and intelligence were tested on such a task. While the overall performance of normal subjects was superior to that of both psychiatric groups, depressives and schizophrenics did not differ. The normal group also showed a significantly greater improvement with pre-instruction than the psychiatric groups; again, the schizophrenics and depressives did not differ significantly, though there was a tendency for schizophrenics to benefit less than depressives from pre-instruction. It appears that ‘filtering’ difficulties as here defined may not be specific to schizophrenia. Alternative conceptualizations of the cognitive abnormalities shown by schizophrenics, such as slowness of information processing and difficulties in response selection, may be more useful.

Work has been a highly valued feature of psychiatric rehabilitation programmes. The performance of patients has often been the object of scrutiny and assessment, but the jobs performed by these patients have not been so assessed. This paper describes the development and use of a job rating scale which parallels the use of patient assessment instruments.

Better Services for the Mentally Handicapped (1971) forecasts a diminution in the number of beds in hospitals for mental handicap. It can be achieved only by the admission of fewer new long-stay patients. This paper considers 50 new long-stay cases admitted to a hospital for mentally handicapped in the five years 1970 to 1974. Of these admissions 42 per cent were children, and of all the admissions 54 per cent had Wechsler intelligence quotients under 25. Further, 62 per cent of the admissions were for behaviour problems and 38 per cent were for physical infirmity and helplessness. It is concluded that there are some mentally handicapped people who have problems with which only a hospital can cope. The high nursing dependency and the profound mental retardation of a majority of the new long-stay patients present a formidable challenge.

Three-hundred-and-thirty cases of unnatural death, leading to 110 open verdicts, 110 verdicts of suicide and 11o of accident, from the Inner West London Coroner's District have been examined to see if particular coroner's officers or pathologists were associated with disproportionate numbers of suicide verdicts. No significant deviations from the expected numbers were found. Coroner's officers probably share common ideas about the features defining suicide, and so do pathologists.

Two cases of chronic monosymptomatic psychogenic eye pain with abnormal illness behaviour are presented. Both failed to respond to a wide variety of treatments, and despite the accepted low suicidal risk in hypochondriasis both killed themselves. The origin, prognosis and therapy of such behaviour are discussed in this context.

A double-blind prospective study was carried out comparing the prophylactic effect of maprotiline and lithium carbonate over a period of one year in patients suffering from recurrent affective disorders. The average Affective Morbidity Index was lower, but not significantly so, in patients treated with lithium. A further analysis, based on dividing patients into those with no affective morbidity and those who showed some affective morbidity during the study, demonstrated lithium carbonate to be significantly superior to maprotiline both in the group as a whole and in unipolar depressives. A correlation between high plasma maprotiline concentration and low morbidity was observed and was in line with an earlier report. A highly significant negative correlation (r = −0.97; p < 0.001) was found between plasma maprotiline concentration and body weight. Although the results showed lithium carbonate to be superior to maprotiline in the study, it should be emphasized that the plasma levels of lithium were constantly monitored and maintained at what is considered to be its optimum concentration, whereas the maprotiline treated patients were kept on a fixed dosage regime irrespective of plasma levels.

Correlations were made between ratings on the Hamilton Rating Scale for depression and the Inventory for measuring depression devised by Beck. Satisfactory and significant correlations were observed in only two-thirds of the patients, and often very divergent results were found in the remaining third.

Hyperkinetic movement disorders may occur as side effects of antipsychotic drugs; and a hyperdopaminergic state induced by the neuroleptic compounds is thought to be a cause of extrapyramidal disorders such as tardive dyskinesia. We have observed two cases of the dyskinetic syndrome in patients receiving tricyclic antidepressants (TCA). Because the TCA are known to have little effect on striatal dopamine but do share with the neuroleptics potent anticholinergic activity, these cases appear to support the hypothesis that the drug-induced hyperkinetic disorders are related to a diminution of CNS acetylcholine activity as well as to an increase in dopamine activity.

Significant sibling-sibling and within-family correlations of human red blood cell catechol-o-methyl transferase activity have suggested a high degree of genetic control over levels of activity of this catecholamine-related enzyme. However, family studies do not disentangle genetic from environmental similarities as causative of within-family correlations. We therefore undertook a human twin study using the monozygotic-dizygotic comparison method. Twelve pairs of monozygotic twins had an intraclass correlation of .90 in red blood cell catechol-o-methyl transferase activity, and seven pairs of dizygotic twins had an intraclass correlation of .37. Heritability of the enzyme activity was estimated by different methods as between 68–100 per cent.