The article describes the outcome of a comparative study of home care, by a trained nurse, versus hospital out-patient supervision in the management of chronic psychiatric patients in Bangalore, India. Twenty-five patients, with a mean duration of illness of nine years, were started on the home care programme while a matched control group of 25 similar patients continued the regular out-patient contact offered by the hospital. Comparative assessments were carried out on the groups at the time of intake and again after two years. The results indicate that hospital admission was less often needed among the home care group.

In a review of the 1967 group psychotherapy literature, MacLennan and Levy (1968) record that nearly 300 papers were published in that one year. Unfortunately, this proliferation does not reflect any great increase in the knowledge of group psychotherapy processes. There are plenty of original ideas, but these are almost totally unsupported by systematic theory and research. Where theoretical ideas have been used, they have been lifted from the sphere of individual psychotherapy and applied unmodified to group psychotherapy. The research has largely been concerned with determining such things as the most efficient group structure; who talks to whom about what; and what grammatical forms are used.

The Rorschach method is valuable in the study of personality and claims have been made for its application to clinical diagnosis. Clinicians would welcome any method which would help to distinguish “psychoneurotic” from “organic” disease. There is a tendency, however, to demand from a new and unfamiliar method a complete diagnosis, rather than that the technique should provide standardized information which can be used towards a diagnosis by the clinician along with other methods. Psychologists using the Rorschach method have played into this expectation to some extent and have sought to present sets of signs and types of Rorschach records which could be considered as suggesting certain definite diagnoses. This paper is concerned with the study in a wide range of patients of some of the signs obtainable by the Rorschach technique in an effort to determine what degree of specificity can be attributed to them, and what likelihood of success and failure is attached to their use.

I should like to congratulate the Council of the Section on their decision to devote an evening to a historical subject. I cannot, I fear, congratulate them on their choice of a speaker, for I have done no more than scratch the surface of a very obvious period in the history of psychiatry. However, any sort of historical paper must be better than none, for as far as I have been able to ascertain no such paper has ever been read in this Section, with the exception of the Presidential Address delivered by the late Dr. Hubert Norman. Until a few months ago, exactly the same was true of the Section of the History of Medicine, but in recent months we have had two welcome and refreshing papers by Dr. Burns and Dr. Zelmanowits. We have had, too, the brilliant Maudsley Lectures by Prof. Lewis and Dr. Rees Thomas. Perhaps we may take it that these are signs of a renewed interest in the history of our specialty. I am sure that no branch of medicine needs it more.

The function of religion in human society is complex. The part played by religion in psychiatric disorders is even more obscure. Previous literature and theories are divided into two groups: one school believes that intense religiosity is a symptom-complex indicative of psychiatric disorder, while the opposing view is that religious belief in some way acts as a defence mechanism protecting the individual and his psyche.

The present study of 50 Jehovah's Witnesses admitted to the Mental Health Service facilities of Western Australia suggests that members of this section of the community are more likely to be admitted to a psychiatric hospital than the general population. Furthermore, followers of the sect are three times more likely to be diagnosed as suffering from schizophrenia and nearly four times more likely from paranoid schizophrenia than the rest of the population at risk.

These findings suggest that being a member of the Jehovah's Witnesses faith may be a risk factor predisposing to a schizophrenic illness. Further studies would be interesting in investigating whether pre-psychotic people are more likely to join the sect than normal people and what part (if any) membership has in bringing about such a breakdown.

Systematic desensitization is unquestionably the most popular of the behaviour therapies. To circumvent several difficulties specific to this technique we devized a new treatment paradigm—the reciprocal inhibition of anxiety by aversion relief (Solyom and Miller, 1967), from which 31 of 40 phobic patients (80 per cent) benefited (Solyom, Kenny and Ledwidge, 1969). The present paper reports on a systematic comparison of the two treatment techniques in terms of: (1) the rate and degree of improvement; (2) the specificity versus the generality of improvement; (3) prognostic indicators favouring one treatment over the other.

An earlier paper (Kay, Beamish and Roth, 1964b) described 26 features that differentiated significantly between mentally normal and functionally ill subjects over the age of 65, or between normals and those with organic mental illness. These features were found to fall into four main groups concerned with (i) physical disability, (ii) social isolation, (iii) personality deviation, (iv) social and income status. Many of the features appeared clearly to be inter related, but to an unknown degree, and this complicated the interpretation of the results. In the hope of shedding some light on this problem, a factorial analysis of 34 features, including most of the 26 previously described, was carried out. Because of missing items, the number of patients was reduced by 27 to 267, consisting of 152 mentally normal subjects, 88 subjects with functional illness, and 27 with organic mental illness. This report is complementary to the two previous articles (Kay, Beamish and Roth, 1964a, 1964b), in which the method of selecting the subjects and the definitions of organic and functional disorder are fully described.

In a recent review of the structure and function of aminergic systems Iversen (1980) paid particular attention to the dopaminergic (DA) and noradrenergic neurones (NA) and only mentioned in passing those with 5HT as a transmitter. Although the original work on the low concentration of 5HIAA, the metabolite of 5HT, in CSF of depressed patients (Ashcroft et al, 1966) which brought serotonin to the attention of biological psychiatrists may not have stood the test of time, nevertheless, recent information on the behavioural consequences in animals of drugs and lesions which influence the output of the 5HT system suggests it plays a role in the development of pathological mood and behaviour in affective illness. This is reflected in the resurgence of clinical interest in antidepressant drugs designed to affect specifically the 5HT system and emphasizes the need to continue animal and clinical exploratory experiments on serotonergic function.

In this study we have compared certain personality variables in alcoholic individuals, depressed subjects and in controls.

A psychiatric consultation was requested in 51 in-patient cases of HIV infection. Reasons for referral included counselling, the evaluation of depressive symptoms, and the treatment of delirium. The most common DSM–III diagnoses included: delirium (n = 13), major depressive disorders (n = 12), dementia (n = 5), and adjustment disorders with depressive or anxious mood (n = 5). The psychiatric treatment of patients with HIV infection does not differ fundamentally from that of other medically ill patients with similar psychiatric symptoms. However, the psychiatric treatment of patients with HIV infection can be hampered by the fear of contagion, negative attitudes towards homosexuals and drug users, and overidentification or avoidance reactions.

Computerised tomography (CT) was used to assess the possible effects of substance abuse on brain morphology. Polydrug abusers had significantly wider third ventricles than normal controls, with a positive correlation between age and ventricle:brain ratio (VBR). Assuming no effect of age, estimated quantity of substance abuse was not significantly related to ventricular and sulcal measures, except that alcohol consumption correlated positively with VBR and severity of cocaine use correlated negatively with sulcal width. When age of the subjects was partialled out, alcohol use showed a tendency for association with VBR; however, severity of cocaine use did not remain a significant predictor of cortical sulcal width. The findings suggest that chronic use of alcohol, but not necessarily of other commonly abused substances, produces brain atrophy.

In 1965, the Department of Social and Preventive Medicine of King George's Medical College, Lucknow, established an Urban Health Centre in the Alambagh suburb of Lucknow city and registered 500 families representing a cross-section of the resident population with the purpose of training undergraduate and postgraduate medical students in the practice of community health (Gupta, 1966).

Psychiatric disorders occur among all groups of the general population, but it would be difficult to suggest a group of young people in whom the consequences are more serious than that of university students. So much is at stake during the short time spent at university that students cannot afford to be ill for any reason, least of all from psychiatric disorders where the ability to study, the first requirement of all students, is especially impaired. Much of the concern with which university authorities view the mental health of their students is due not only to the widely-assumed relationship between psychological illness and poor academic performance, but also to an increasing awareness of the central role played by emotional factors in the adjustment of the young adult to the new, competitive and often demanding world of higher education. Certainly the suicide rate is one criterion of mental illness which suggests that students are exposed to special risk: it is many times greater for undergraduates than for the equivalent age groups of the general population (Carpenter, 1959; Parnell, 1951; Parnell and Skottowe, 1957). While the suicide rates are high, particularly among students at the older English universities, the actual numbers are very small, and suicide is fortunately only a rare expression of psychological illness among students. Carpenter's (1959) analysis, showing that suicide rates differ in different universities (annual rates of 0.2 per 1,000 living students at Oxford and Cambridge, 0.06 per 1,000 at other British universities), has prompted speculation by university physicians as to whether the case load of psychiatric morbidity among students varies from university to university, and whether this is influenced, adversely or beneficially, by differing cultural and environmental factors in the universities and differing social and demographic characteristics of the student populations.

Much current research in psychiatry proceeds in the absence of an integrated model of brain function. It is based instead on the effort to relate clinical syndromes to single, localised abnormalities in the brain. Such an approach is inconsistent with existing data, inadequate for linking research findings with clinical practice, and, probably, fundamentally misdirected. A model of brain function is presented that is based on Luria's notion of cerebral functional systems and on the proposition that the neural substrates of emotion are those processes that integrate different brain regions. Some of the implications of this model for research are discussed.

The National Strategic Framework for Renal Services introduced the routine reporting of estimated glomerular filtration rates (eGFR) on serum urea and electrolyte tests. Estimated glomerular filtration rates might reduce renal failure induced by lithium and cardiovascular mortality but there are many false positives. We propose how eGFR might be used in lithium monitoring.