For many years it has been the policy of the London Authority to avoid the certification of patients directly from their own homes, by passing them through an observation ward before making a decision as to their disposal. The system originated partly from the fact that the London Mental Hospitals are some distance from town, and partly from the shortage of accommodation, it being necessary to secure the safe custody of the patients pending their admission. The small scattered wards have now been fused together to form larger and more efficient units, which ensure every case having the fullest consideration and investigation before deciding upon any method of disposal. The various points arising in this paper are illustrated by reference to the work of the largest of these units.

“This paper reviews the recent empirical studies on psychosocial family intervention in schizophrenia. Six family educational intervention studies and five more intensive family work studies with 2-year follow-up have been included. A series of questions is asked relating to the effects of such interventions, the efficacy of the different educational models, the active ingredients of these multi-component treatment packages, and the contribution of this new generation of studies to our understanding of the mechanisms through which these interventions work. Suggestions for further research are made. Finally, from the published manuals, the common components of these diverse, multi-component treatment packages of different family-intervention studies are identified.”

Predominant psychopathology in a selected population group - adolescents and young adults at school - in a developing country, is described. The highly selective referral to services was supplemented by active case finding in the community over three years. There were 54 cases of somaticised anxiety (brain fag); 22 cases of depressive neurosis characterised by hypochondriasis, cognitive complaints, and culturally determined paranoid ideation; 23 cases of ‘hysteria’ in the form of dissociative states, pseudoseizures and fugues; and 39 cases of brief reactive psychosis which differed from the dissociative states more in duration and intensity than in form. There was a temporal relationship between transient psychosis and the school calendar. Anxiety or depression often predated the florid psychotic reaction which served as a form of help-seeking behaviour or defence in intolerable stress.

Affective flattening is a disorder of emotional expression, of which a good definition is ‘a gross lack of emotional response to the given situation’ (Fish, 1962). It is a clinical sign whose assessment depends upon the clinician's intepretation of the patient's facial expression, tone of voice and content of talk (Harris ' Metcalfe, 1956). Although these are subtle cues, it has been shown that experienced clinicians can assess the severity of affective flattening with a high level of inter-rater agreement (Miller et al., 1953; Harris ' Metcaife, 1956; Wing, 1961; Dixon, 1968). The disorder is usually associated with a diagnosis of schizophrenia, although it may occur in other conditions, such as the organic psychoses (Bullock et al., 1951).

This paper describes the ‘rural guardianship network’ method of managing persons with severe mental illnesses and reports on a retrospective case–control study that compares the outcome of 561 schizophrenic patients from townships with guardianship networks to that of 103 schizophrenic patients from a township without guardianship networks. Each patient enrolled in a guardianship network is assigned a guardian – usually a family member – who ensures that the patient takes medication and gets medical follow-up, and reports any changes in the patient's condition to the village health worker or the township doctor who is responsible for psychiatric care. These guardians are supported and supervised by management groups at the village and township levels composed of government officials, medical administrators, physicians from township hospitals, and village health workers. Compared with patients who are not enrolled in guardianship networks, enrolled patients have significantly lower rates of hospital admission, lower rates of socially disruptive behaviour, and lower levels of psychopathological symptoms. The rural guardianship network is an effective and economical means of providing close supervision of mentally ill patients in their homes.

Changes in the excretion of adenosine 3’:5′-cyclic monophosphate (cyclic AMP) have been reported in depressive illness. Abdulla and Hamadah (1970) reported that urinary cyclic AMP excretion was lower than normal during depression and increased with recovery. However, these results were based on single 24-hour urine collections during depression and on recovery, with no creatinine estimations to suggest that the collections were complete. There was no control of diet, drugs or activity. The controls do not appear to have been matched for age. Paul, Ditzion, Pauk and Janowsky (1970) reported that the cyclic AMP excretion in neurotic depression was higher and in psychotic depression was lower than in a control group, but neither difference was statistically significant. However, on enlarging the study by including more psychotic depressives they reported that the cyclic AMP excretion of this group was significantly less than that of the controls (Paul, Cramer and Goodwin, 1971). These workers had controlled the patients' drug and dietary (but not fluid) intake. There appeared to be only minimal control of activity. The results were based on approximately two samples of urine per subject, which were very carefully checked for completeness of collection. Unfortunately the age of the controls (19–22 years) was very different from that of the patients (25–64 years). On two small groups of patients treated with either Laevodopa or lithium carbonate, they reported that changes in affective state were accompanied by changes in the urinary excretion of cyclic AMP. However, in serial studies on manic-depressive patients Paul, Cramer and Bunney (1971) failed to show a correlation between mood rating and cyclic AMP excretion in five out of seven patients; but they reported that the cyclic AMP excretion was increased on the day of rapid switch from depression to mania. The above groups of workers had used an enzymatic-isotope displacement technique to estimate the cyclic AMP. Brown, Salway, Albano, Hullin and Ekins (1972), using a saturation method to assay cyclic AMP, found no correlation between mood and cyclic AMP excretion in two short-cycle manic-depressive patients. Jenner, Sampson, Thompson, Somerville, Beard and Smith (1972) wrote: ‘We have measured daily excretion by a number of depressed and manic depressive patients over periods covering several mood changes without being able to establish any consistent correlation between cyclic AMP excretion and mood, … However, in one unusual case we have found a very marked correlation‘. We (Naylor, Dick, Dick, Moody and Stansfield, 1974) were unable to demonstrate any relationship between urinary cyclic AMP excretion and mood in a patient with recurrent psychotic episodes, in which depressive features predominated.

Since the initial review of patients in Glenside Hospital (Cooper and Early, 1961), a number of surveys have been carried out—Gore and Jones (1961), Norton (1961), Hassall and Hellon (1964), and Hassall, Spencer and Cross (1965). These studies are not directly comparable and all contain elements of subjective assessment.

Previous studies have shown that in-patients in psychiatric hospitals may not always take prescribed drugs reliably (Hare and Wilcox, 1967; Wilson and Enoch, 1967; Irwin et al., 1971).

Many endocrine disturbances have been described as accompanying disturbances in mentation. Single investigations giving a static picture at a certain stage of the disease contribute comparatively little to the understanding of the pathognomonic significance of the biochemical change, even if they are found to be statistically significant.

The construction of a semi-structured interview depression scale that is sensitive to change for use in the elderly is described. Depression items from a well validated diagnostic instrument, the Geriatric Mental State Schedule (GMSS), were used as the core items in the development of the instrument. Improvement in depression in 80 elderly patients was independently assessed with two standard rating scales for depression, the Hamilton Rating Scale for Depression and the Beck Depression Inventory, and by an independent clinician's judgement before and after standard antidepressant treatment. Depression items that were sensitive to change were retained from the core items to form the new instrument. Results indicate that this scale is reliable and valid, shows better correlation with both the clinician's and the patient's judgement of improvement than the standard instruments, and is sparing of the rater's time.

The models of psychiatric rehabilitation described in this supplement evolved in response to a change in the official attitude to the disabled and to the provision of welfare services that has arisen since the start of China's reform era in 1978. The traditional ‘residual’ welfare that provided the minimum services needed to prevent social unrest (Chan & Chow, 1992) has been transformed into a pro-active form of welfare that identifies disadvantaged and disabled persons in the community and provides them with support and rehabilitation. Perhaps the most dramatic indication of the new status of the disabled in China is that the opening ceremony of the Second National Congress of the China Disabled Persons' Federation on 6 October 1993 was held in Beijing's Great Hall of the People, and President Jiang Zemin, Premier Li Peng and “all China's top Party and government leaders” were in attendance (Liang, 1993).

The poor prognosis of narcotic dependence is generally recognized, but this is a field in which it is specially difficult to make predictions about the outcome of treatment in the individual patient. Vaillant (1966a) noted that abstinence appears to depend more on the addict's ability to discover satisfying alternatives to his addiction than on methods of treatment. In an attempt to identify prognostic indicators in narcotic dependence a number of follow-up studies have examined the relationship between outcome and various social and psychological characteristics of the patients studied. While most follow-up studies are of male addicts or of samples containing only a small proportion of women, the present study is concerned with the outcome in a sample of 66 female narcotic addicts.

Two methods for predicting steady-state serum lithium level were compared prospectively in in-patients suffering from affective disorder. A single-point prospective administration model that required a single 24-hour serum lithium level, following a test dose produced statistically similar predictions of the observed steady-state lithium levels as did a model that required 12- and 36-hour levels. However, the latter two-point method produced significantly more accurate predictions from clinical interpretation. Although the two-point approach is preferable, the single-point method is clinically acceptable if its limitations of accuracy are taken into consideration.

Nitrazepam (Mogadon), a benzodiazepine compound, chemically related to diazepam (Valium) and chlordiazepoxide (Librium) is a recently introduced sleep-inducing agent. Other studies (Baum et al., 1965; Fraser and Shepherd, 1966), found it to be both safe and effective. It is thought to induce sleep by “shielding the brain centre responsible for waking from emotioned stimuli”, and is therefore of particular interest for psychiatric illness. This study is a clinical comparison with sodium amylobarbitone, using a double-blind cross-over technique.

During a study of drug incidents dealt with in one month by 62 casualty departments in Greater London, 395 drug-dependent individuals were identified. The great majority of these patients were seen in hospital following an overdose, and barbiturates were the drugs used most frequently. A high incidence of multi-drug use was noted, and many individuals had obtained their drugs from an illicit source. A history of repeated overdosing was common, and one fifth of the patients behaved aggressively while they were in casualty. The implications of these findings are discussed, with particular reference to the demands that are made on casualty departments by drug-dependent individuals.

In rats, neither acute administration of ethanol nor the establishment of ethanol dependence by chronic administration for 28 days produced significant 1H-NMR relaxation changes. However, chronic ethanol intake for six months produced a transient rise in T1, with no change in T2 or water content. The significance of these results for study in man is discussed and a hypothesis is proposed to explain discrepant differences between T1, T2 and water content. It is suggested that T1 change with long-term ethanol exposure is related to altered free/bound water state secondary to cell membrane changes.