The following case study offers an exceptional opportunity to illustrate the wish-fulfilling nature of auditory hallucinations in a hysteric (Breuer and Freud, 2; Freud, 11), the conditions under which these hallucinations are experienced, and their response to treatment.

The authors of the King's Fund report on London's mental health services (Johnson et al, 1997) argued that the formula used by the Department of Health to allocate resources to health authorities fails to meet the needs of inner cities. It is difficult to explore this issue because the principal allocation to district health authorities is set out as a single figure, with no subdivisions for separate clinical areas. This differs from local government finance, where annual allocations are itemised in a report detailing both major components (education, social services and road maintenance), and subdivisions of these (House of Commons, 1998). However, in the process used by the Department of Health to calculate health service allocations, several areas of clinical work, including the care of the mentally ill and learning disabled, receive distinct consideration. An annual publication sets out the detail (NHS Executive, 1998). Slight reworking allows the identification of implied allocations for the following clinical areas: general and acute; mental illness and learning disability; and other community care. This paper outlines the methodology and shows the allocations to health authorities in England for 1990–2000.

In a previous study of old people living in the community, those with functional psychiatric disorders (usually neuroses) were found to have relatively low IQs on the Wechsler Adult Intelligence Scale (WAIS) (Britton et al., 1967). This observation required confirmation and was open to a number of interpretations.

All consultants in general psychiatry appointed in Britain between 1 October 1975 and 30 September 1978 were sent a questionnaire asking about their training and adequacy of experience before making a final decision. Over a quarter of the respondents were women, of whom a third had trained part-time. Family circumstances and availability of part-time posts were important determinants. Overseas graduates formed another quarter. For many psychiatry was not their first love but availability of posts and status were important factors in choice of career. Many consultants felt they lacked experience in the subspecialties within psychiatry.

Staffing patterns are a major concern in the planning and administration of psychiatric facilities. The cost of professional and sub-professional personnel are the largest expense on psychiatric institution operating budgets. Trained professionals are in short supply and for the foreseeable future will not be available in adequate numbers to staff existing and developing programmes. Such considerations make important the development of more efficient methods for deciding upon staffing levels. At present, clinical experience and uncontrolled comparison of differently staffed clinical programmes are the usual justifications for improved staffing. This study was undertaken to investigate whether a relationship existed between staff time spent in treatment of patients and outcome for a patient group.

Obsessive-compulsive disorder is extremely rare among mentally retarded people. We report here a case of a mildly mentally retarded woman who exhibits contamination obsessions, compulsive hand-washing rituals, and avoidance.

At present the phenothiazine drugs constitute the medication of choice in the treatment of schizophrenia. While in most schizophrenics treatment with phenothiazines does ameliorate the symptoms of the disease there are a certain number of patients who remain resistant to therapy. In such patients the side effects caused by phenothiazines may also be less pronounced or completely absent.

There is a consensus of opinion among the staff of psychiatric hospitals that it is in the best interests of the patients to be occupied during their hospital stay. In most hospitals of this type workshops have been set up for the patients and these are variedly regarded as amenities and therapeutic tools. The workshops vary a great deal in their characteristics, but broadly fall into two categories: occupational therapy units and industrial units.

A case of tuberculous Addison's disease presenting with psychosis, profound hyponatraemia, and detectable plasma antidiuretic hormone is reported. Clinical and biochemical improvement after corticosteroid replacement was followed by relapse with further psychosis and inappropriate antidiuretic hormone secretion: both were promptly reversed by demethylchlortetracycline. The association of psychological symptoms with Addison's disease, the role of anti-diuretic hormone secretion in Addison's disease, and the inter-relationship between Addison's disease, psychosis and anti-diuretic hormone secretion are discussed.

Marital interaction appears to be relevant to alcoholism. This study compares two groups of couples, each presenting with sexual dysfunction. One group has an alcoholic member in each couple, one group does not. Data are presented suggesting that alcoholic marriages can be distinguished, in a clinically useful way, from other troubled marriages. Alcoholic husbands feel submissive, but are not being forced by their wives to be so. This suggests a therapeutic approach different from the one that would be taken if the wives were actually dominating.

Some patterns of deranged function—epilepsy, schizophrenia—have been enshrined as diseases; others, such as depersonalization, have, by and large, escaped this fetter. This is perhaps why there has been no difficulty in accepting that depersonalization, being a pattern of disordered function, can occur in conditions of very different aetiology. It is seen in temporal lobe epilepsy (12), temporal lobe migrane (22), depression (8), LSD intoxication (20), schizophrenia (1), phobic anxiety states (15), sleep deprivation (2) and the hypnagogic state. Shorvon (21) reported cases of depersonalization occurring in the apparent absence of other psychiatric disorder, and Davison (4) investigated in detail seven such cases. Finally the occurrence of depersonalization in people not attending psychiatric or neurological clinics is now well attested (13, 5, 18, 6).

The purpose of the present paper is to draw attention to a remarkable similarity in the age-incidence curves of schizophrenia and neurosis when the sexes are combined. Hare and Price (1969), in a study on the season of birth of schizophrenic patients, found that the age-distribution of cases of schizophrenia (I.C.D. 7th Revision nos. 300, 303) seen for the first time at the Bethlem-Maudsley Hospital during the years 1951–1963 was very similar to that of the cases of neurosis (I.C.D. nos. 310–18) seen there during the same period. However, these cases included out-patients as well as in-patients, were not necessarily first-ever attendances at a psychiatric clinic, and, because they had been referred to a teaching hospital which did not serve a particular geographical area, may have been a somewhat unrepresentative series. For these reasons, their findings (illustrated in Fig. 1 of their paper) might have been no more than a coincidence.

The reporting of suicide inquests by a provincial evening paper has been examined. Inquests on violent and youthful suicides were given more reports, larger reports and more eye-catching headlines.

In an investigation of the relation between life events (stressors) and illness, 87 medical students reported on a prospective basis their health and life events history over a three year period. There were a few positive findings, e.g. that subjects who reported more life events during the period also reported more illnesses during that period. Overall, however, the study showed a lack of statistically significant association between life events and illness.

A group of alcoholics treated by partially reinforced electrical escape conditioning were found to have a significantly better outcome on follow-up than a selected control group, who showed a parallel level of motivation, and were treated by conventional methods. No sex differences in outcome were found for either group. In the experimental group, better prognosis was associated with higher social class and older age, and poorer prognosis with single marital status. There were no variations in outcome for age in the control group. In the age range 20–40 aversion therapy showed no better results than conventional therapies, but with subjects above this age range it was very significantly superior. The results are discussed with reference to the application of aversion therapy to alcoholism.