A comparison has been made of costs within in-patient units in a large Scottish psychiatric hospital. Cost differences were found between short-stay, rehabilitation and long-stay psychosis units and beds for the elderly with mental disorder. These differences reflected staffing levels, particularly of nurses. The costs were greater than average for psychiatric hospitals and approximated to geriatric units—a finding in keeping with the high occupancy of beds by the elderly. Existing long-stay elderly patients require to be considered separately in distinguishing elderly in-patient costs without total psychogeriatric care offered by society.

Out of 1279 first-year undergraduates, two matched groups of students potentially vulnerable to psychological disturbance were identified. One was left to its own resources; the other was offered psychotherapeutic intervention, the effects of which were measured by the number of consultations with general practitioners, type of treatment and rate of withdrawal from university. Although the students in the intervention group had fewer consultations, lower General Health Questionnaire scores at follow-up, and fewer withdrew from university, due to the small numbers involved none of these differences achieved statistical significance.

Older people in institutions are often disabled by physical disease (Wilson et al., 1962). Psychiatric patients, in general, have more somatic disorders than mentally healthy people (Westrin, 1961; Shepherd et al., 1964; Maguire and Granville-Grossman, 1968). In fact, most elderly long-term psychiatric patients in hospital suffer from one or more somatic disorders (Ask, 1962). Even a small improvement in the general health of these patients may be of importance for their daily life activities, and also reduce the requirements for assistance. An established regular somatic screening of these patients will help to detect disease which otherwise may be over-looked.

Attempts to repeat in human subjects animal studies in which naloxone stopped withdrawal symptoms after prolonged use of heroin failed. Nevertheless, suggestions for further studies are made, as the subjects' subsequent desire for opiates did seem attenuated.

Two cases of pre-partum psychosis are described. Both patients had previous episodes of puerperal psychosis but no non-puerperal illnesses. The possible relationship of pre-partum and post-partum psychosis is discussed.

For a long time it has been thought that deviations from the average in certain body measurements might be associated with an increased expectation of mental illness. The features to attract most interest have been size, linearity, and masculinity.

During the past two decades the psychosocial environments of psychiatric wards have become of increasing concern. Different investigators have described the importance of the therapeutic milieu of such wards and have implied that treatment environment strongly influences treatment outcome. At first there were detailed observations and naturalistic descriptions indicating the importance of ward social structure in facilitating or hindering treatment goals (Stanton and Schwartz, 1954; Caudill, 1958). Then came a variety of different types of ward programmes designed to use the ward environment as an important treatment modality (Jones, 1953; Cumming and Cumming, 1962; Fairweather, 1962). These different approaches present quite different specific recommendations about the most effective types of treatment environments; however, they do all agree on one essential point: that the immediate psychosocial environment in which patients function is an important determinant of the outcome of the treatment process.

Depression is a very common condition, and most depressed patients in many countries are treated by their General Practitioners. It is a frequent cause of suicide – one of the major causes of death in young adults – and is the disorder most commonly associated with deliberate self-poisoning, a large percentage of suicides being due to poisoning with drugs that are only available on prescription. Self-poisoning with older tricyclic antidepressants (TCAs) poses major clinical management problems, since the majority of patients who overdose with these agents do not reach hospital alive. Though there is no convincing evidence that any one antidepressant is more effective than others or more rapid in onset of therapeutic action, antidepressants do differ substantially in their side-effect profiles and in their toxicity in overdosage, those introduced before 1970 being relatively more toxic. Since suicide rates have been reduced by limiting the availability of toxic substances such as barbiturates and harmful domestic gas, restricting the use of older antidepressants in favour of newer, safer compounds for depressed patients being treated in general practice would also seem to be advisable.

The impact of a 16% increase between censuses in the population aged 65 and over, on a psychogeriatric department whose bed complement remained static between 1974 and 1984, has been studied. Demand for service, as measured by new referrals, rose by 150%, while admissions fell by 14%. The increase in new referrals was uniform across the diagnostic spectrum, but the fall in admissions was not. Functional admissions fell in all age-groups except that of women of 85 and over, while organic-case admissions other than for cases of dementia virtually collapsed. Overall admissions for dementia rose to the predicted level, but the distribution of the increase was irregular and unexpected. Admissions of males and females aged 65–74 and females of 85 and over fell relatively and absolutely, while those of women aged 75–84 and men of 85 and over were little changed. Only admissions of men aged 75–84 alone increased in real terms.

The purpose of this paper is to report on therapeutic measures which have been used on my Unit at the Maudsley Hospital for several years and have been gradually elaborated with the help of registrars who have learned to apply them under my general supervision. The measures are derived from the therapeutic technique Freud recommended. In 1913, when he reviewed the development of his technique, he said: “In the earliest days of analytic technique we took an intellectualist view of the situation. We set a high value on the patient's knowledge of what he had forgotten, and in this we made hardly any distinction between our knowledge of it and his…. We hastened to convey [it] to the patient in the certain expectation of thus bringing the neurosis and the treatment to a rapid end.

Twenty patients with dementia were assessed by two raters, using the Standardised Psychiatric Interview of Goldberg et al (1970). Inter-rater reliability was good or fair for many items, but test–retest reliability and validity were less good. A single interview does not appear to provide a full picture of psychiatric (excluding cognitive) symptoms in demented patients.

The quarter of birth of 536 schizophrenic, 1,991 neurotic and 12,085 psychiatrically normal twin pairs from the National Academy of Sciences-National Research Council Twin Registry was compared. When either all twin pairs, or only monozygotic or dizygotic twin pairs, were considered, no significant differences were found in the quarter of birth between the 3 groups. No difference in quarter of birth was found for twin pairs concordant versus discordant for schizophrenia. Despite the increased risk for intrauterine and perinatal complications in twin births, schizophrenic twins appear (at least) to be no more vulnerable than schizophrenic singletons to the seasonal gestation and birth-related insults which probably underlie the seasonality in schizophrenic births. Controlling for season of birth probably has little effect on the results of twin studies of schizophrenia.

An occurrence of Gilles de la Tourette's syndrome in a 13-year-old Saudi female patient is documented, and treatment is described. It is thought that the improvement noted may be attributed to the hospital environment and reduced contact with the family.

It has long been my wish to review the early history of the Maudsley Laboratories, which were my working home for many years. While I was on their active staff, however, I was forced to postpone this plan in favour of more pressing problems.