Reported here is a cohort study of five years' bed usage in the Goodmayes Psychiatric Unit for Old People. Patients first admitted in 1970 continued to use beds, by readmission or by continuing stay, over the next four years; subsequent cohorts of admissions made correspondingly extended use of beds. Bed-usage by men appears now to have stabilized, whilst for women it is still rising.

Over the first six years the bed complement was reduced by 40%, despite an increase in referrals of over 40%; this is because the Unit's style of work prevented newly admitted patients from accumulating in beds made available by deaths. It looks as if in future not only will patients who die be replaced by new female admissions but more beds will be needed for these admissions. The present bed-usage is just within the Government's recommended guidelines, and the local issues are considered in the context of national policy.

Among 231 cases of manic-depressive illness parental loss before 17 years was high but was not associated with earlier onset of illness.

In recent years research workers have shown a relative lack of interest in the constitutional correlates of normal personality. However, recent findings in the field of psychosomatic medicine suggest the need for a careful reexamination of this field of research. Several studies have indicated that breast cancer, lung cancer, and myocardial infarction patients are more extraverted and less neurotic than hospital control group patients (Eysenck, 1965). Also, duodenal ulcer patients have been reported as being both introverted and neurotic (Kanter and Hazelton, 1964).

In the world of mental diseases schizophrenia may well be termed “the sickness that destroyeth in the noonday.” Although the replacement of Kraepelin's nomenclature of “dementia praecox” by Bleuler's term, “schizophrenia,” has carried with it a general recognition that the chance of recovery is better than had been originally anticipated, the doom of those who do not recover is amongst the most dreadful meted out by any disease. It so frequently means a body apparently fully alive with a mind permanently impaired or virtually dead. Despite the obvious desirability of assessing the prognostic chances of the individual case, the statistical works published up to date have failed to establish agreement as to how this may be done. The object of this paper is to combine a detailed examination of the literature with a personal study of the histories of over 100 cases of schizophrenia in an effort to reach a definite conclusion in this matter. The paper will be divided into the following parts: I, a detailed survey of the literature; II, the outcome of 120 cases studied by myself; III, a comparison of remission rates and prognostic factors in cases treated by cardiazol.

Picture material may be “described” or “interpreted”. This distinction (further discussed in the section on Analysis of Results) is related in part to the complexity of the material, in part to the kind of response that is required. Defective description of pictures in cases of brain lesion has aroused little comment and has not been claimed to exist as an isolated disability. In contrast impaired interpretation of picture material has been more frequently found in association with disease or injury of the cerebral hemispheres. Moreover there is little agreement concerning the nature of this disability.

In the observations which I am about to address to you, I purpose to set forth by illustrations the character and course of a form of mental derangement which has its special cause, certain characteristic features, and a definite course, almost invariably from bad to worse. I speak of that kind of insanity which is brought on by self-abuse. In doing this, however, I have another object in view; I am anxious to use my exposition in order to exemplify a new and practical classification of insanity which has been proposed and sketched out by Dr. Skae.

The study reported by Marks et al is of considerable importance, since it is the largest clinical trial to date comparing the combination of a benzodiazepine and behaviour therapy to either component alone, and the first combined treatment trial to use alprazolam as the pharmacological agent. It was an ambitious project that was apparently well run, and the findings should be of wide interest. However, the potential value of the study is limited by the method, the patient sample, and the analysis and presentation of the data.

The elctrical resistance of the palmar skin, and the naturally-occurring difference in electrical potential between the palm and the dorsal surface of the forearm show simultaneous changes in response to sudden or emotionally-laden sensory stimuli (the ‘galvanic skin response’ or GSR). Spontaneous GSRs occur during wakefulness, especially in anxiety states, but they are reduced by general relaxation and it might be supposed that they would be absent during sleep of uniform EEG appearance. However, Oswald et al. (1959) reported that this was not so and that in sleep with very high voltage slow waves (today generally called Stage 4 sleep) there could be present random spontaneous GSR activity, measured by the potential difference technique. Since these electrical phenomena cannot be related to any known stimulus, to call them galvanic skin responses is inappropriate, and they may better be termed electrodermogram (EDG) activity.

A review in South-West Scotland of all patients prescribed lithium for the first time during the years 1972–82 showed that on average, 12 per 100,000 of the general population start this drug each year. By the end of the period, lithium had been stopped in 58% of patients; the most common reason for discontinuation was the development of side-effects, of which tremor was the most frequent. In only 15% was lithium stopped as it was considered no longer necessary; 44% of patients discontinued lithium within one year of starting it.

Benzodiazepine withdrawal has been found to give rise to numerous physical and psychological symptoms. This paper describes, for the first time, Schneiderian first-rank symptoms of schizophrenia caused by such withdrawal.

We ascertained the one-year prevalence of schizophrenia amongst individuals aged 15 years or older living in six villages in a remote area of Botswana. All cases were diagnosed independently by two experienced psychiatrists, following ICD9 rubrics. DSM-III criteria were also applied, separately. Accurate contemporary population estimates of the villages were available. The age-adjusted prevalence of schizophrenia was 5⋅3 per 1000 in terms of ICD9, or 4.3 per 1000 by DSM-III, which has an upper age limit for onset of 45 years. These figures are well within the range generally reported for industrial communities. Remote village life in Botswana appears to offer no protection against the development of schizophrenia.

The familial incidence of affective illness is well documented. Many studies have shown identical twins to be highly concordant for affective illness (e.g. Price, 1968; Tsuang, 1977). Suicide is strongly linked with affective disorder. However, few cases of both twins committing suicide have been described, and the family reported here, in which several other members also committed suicide by violent means, is thought to be of considerable interest.

This paper deals with information obtained from nearly five hundred families in which at least one parent was living with one or more children aged 15 or under. It examines the association between the health of fathers and mothers, and also between that of parents and children. Elsewhere (Hare and Shaw, 1965a) we showed that, in the sample population from which these families came, there was a strong tendency for persons with poor mental health to have poor physical health as well.∗ We took this to support the view that in any population there tends to be a group of persons, comprising some 10 to 15 per cent, of the whole, who are particularly prone to ill-health of all kinds and who make a correspondingly high call on the facilities of the health service. One of the objects of the present study was to try and determine if there were families, as well as persons, prone to ill-health—in other words, whether a high rate of ill-health in (say) fathers was associated with high rates in other members of the family.

A case is reported of a young woman presenting with symptoms of so-called multiple personality disorder. It is proposed that this condition should be viewed as a non-specific psychiatric symptom.