From 1 January 1984 until 30 June 1986 all 517 compulsorily admitted psychiatric patients of a well-defined mixed rural–urban catchment area in Baden-Württemberg, a southern State of the German Federal Republic, were compared with all 10232 voluntarily admitted patients. Because of the very low frequency of compulsory admissions this population can be regarded as a ‘core group’ of committed patients. In a logit analysis the characteristics distinguishing involuntary from voluntary patients can be reduced to three main factors: the diagnosis ‘schizophrenia/ paranoid disorder’, ‘masculine gender’ and the compound indicator ‘not owning a home’, the latter being mainly associated with youth, masculine gender and low occupational status. The strong association of these characteristics with the criteria ‘severity of disease’ and ‘danger to oneself and others’, both pre-requisites for compulsory admission according to the laws of most countries, is discussed.

From an original sample of 177 patients in community care and suffering from functional psychosis, the psychiatric teams involved in the treatment of these patients interviewed 136 patients and 103 relatives. The interviews aimed at determining the patient's problems in socialrole behaviour, as evaluated both by the patients themselves and by their relatives, and to measure the stress caused to the relatives.

According to the patients themselves, over 60% had considerable difficulties in at least one area of social-role behaviour; the same conclusion was reached by over 50% of the relatives. The patients had a more positive view of their abilities to cope with housework, self-care, and managing money than their relatives. One-third of the relatives said they were dissatisfied with the situation, and more than 40% displayed a resigned attitude to the amount of support required by the patient.

Problems in social-role behaviour were commonest in patients who were dissatisfied with their treatment, in male patients, and in patients who lived together with their spouse, and among the relatives dissatisfaction with the situation as a whole was also highest in these cases. On the basis of these findings it is stressed that the treatment of psychotic patients should be based on a broad approach involving not only the patients themselves but also their relatives.

We have reported previously that poorly educated elderly people and those of low social class were at much increased risk of scoring below the customary cut-point on the Mini-Mental State Examination, a widely-used, brief cognitive screening test. As part of the same study, subjects who scored 23 or less on the MMSE out of a maximum of 30 points, and a sample of those who scored 24 or 25 points, were assessed by psychiatrists using a structured, diagnostic interview. Assuming that persons who scored 26 points or above were cognitively intact (our data suggest that 2% or less were not), neither educational attainment nor social class had any influence on the likelihood that subjects would be diagnosed as demented. Our data suggest that social and psychological factors contribute substantially to cognitive test scores and serve to emphasize the importance of detailed assessment procedures in epidemiological surveys of dementia.

The SIDAM – a new instrument for the symptomatic diagnosis and measurement of dementia according to DSM-III-R and ICD-10 – is described. It comprises a brief structured clinical interview, a range of cognitive tests (e.g. including the Mini-Mental State (Folstein et al. 1975)) which constitute a short neuropsychological battery and a section for clinical judgement and third party information. All items rely on DSM-III-R and ICD-10 algorithms. The SIDAM has a high overall test–retest reliability which equally holds true on the diagnostic, criterion and item level. It is a brief (average of 28 min), practical and easily scored diagnostic instrument, which reliably separates subjects with DSM-III-R and ICD-10 dementia from those without such a disorder. Good congruence was found between SIDAM diagnoses and corresponding ICD-9 expert diagnoses. Furthermore, the SIDAM-Score (SISCO) allows a detailed measurement of even low levels of cognitive impairment and provides quantification of severity grading of cognitive dysfunction.

Measures of disease severity are required as experimental, control and outcome variables in studies of the psychosocial aspects of physical illness. The Endstage Renal Disease Severity Index (ESRD-SI) was developed for these purposes during a prospective study of patient adjustment to dialysis and endstage renal disease (ESRD). It was found to have adequate inter-rater reliability, test–retest reliability, and construct and predictive validity in two subsamples (total N = 233) of dialysis patients. The ESRD-SI is suitable as a sensitive indicator of disease severity in these patients.

In 1974, the National Health and Medical Research Council (NH & MRC) in Australia reviewed what initiatives might be undertaken to promote medical research relevant to the needs of the population. It noted that Australia had contributed with distinction in some areas, such as the neurosciences and immunology, whereas fields such as epidemiology and psychiatry were much less developed scientifically. As the principal source of funding for medical research, the NH & MRC had hitherto supported projects, individuals and a small number of institutions (e.g. the Walter and Eliza Hall, the Florey and the Baker Institutes). The initiative adopted in 1974, as an additional commitment, was to establish some research units in areas of major relevance for public health. These were intended to become centres of excellence in fields where more expertise was needed at a national level.