A prospective one-year follow-up of 216 in-patients showed that utilization of aftercare was significantly associated with certain clinical and social factors in the year after discharge from hospital. Rural domicile, a diagnosis of schizophrenia, long dependence on services, and ease of access to care comprised an aftercare dependency syndrome with substantial predictive power. Alcoholic and personality disordered patients were light users of services. Staff—patient relationships and attitudes of staff and patients to the need for aftercare were important. Depot neuroleptics were associated with high levels of aftercare for patients with chronic schizophrenia. The findings reveal the steady silting up of a new area service for the adult mentally ill by patients with a combination of social disadvantage and severe chronic psychosis. Family doctors played very little part in the delivery of aftercare. Some implications of the findings for the future development of community-based psychiatric services are discussed.

Elderly persons over the age of 60 who were admitted for psychiatric care were compared with a random sample of persons living in the same community in respect of psychiatric, medical and socio-economic variables. The group admitted to hospital for psychiatric reasons was very similar to the latter in general characteristics. However, those people admitted to old age homes, which are the other major resource for psychiatric illness, constitute a distinctly separate population, being older and having considerably more physical illnesses and socio-economic problems. Factors predicting admission to an old age home were largely irremediable age-related conditions (dementia, physical infirmity, etc.), but there were also adverse social circumstances, including marked isolation and a lack of social and emotional support. A comparative analysis of the many psychiatric, social and medical factors is presented, with particular reference to reasons for referral and prevention of admission.

Recent research on unemployment and health has depended heavily on macro-social and ecological data analyses. In order to redress this imbalance, the report summarizes the methods and results of a prospective study of a permanent factory shutdown, thereby illustrating and dissecting some of the strengths and weaknesses of the micro-epidemiological level of analysis. This leads to a broader analysis of research strategy questions which consider macro and micro approaches and variations on the two.

With a psychiatrist's standardized clinical diagnosis as the criterion, the ‘Mini-Mental State’ Examination (MMSE) was 87% sensitive and 82% specific in detecting dementia and delirium among hospital patients on a general medical ward. The false positive ratio was 39% and the false negative ratio was 5 %. All false positives had less than 9 years of education; many were 60 years of age or older. Performance on specific MMSE items was related to education or age. These findings confirm the MMSE's value as a screen instrument for dementia and delirium when later, more intensive diagnostic enquiry is possible; they reinforce earlier suggestions that the MMSE alone cannot yield a diagnosis for these conditions.

The interdependence of the three areas of patient improvement assessments used in a comparative study has been studied. The three dimensions are clinical psychopathology, social dysfunction and burden on family. A high correlation has been found between these dimensions. The differential effect of two modalities of treatment delivery on the interdependence of these three dimensions is discussed.

Andrews' method of plotting n-dimensional data in 2 dimensions allows one to summarize all the data on one patient using a single curve. Comparisons have been made between different diagnostic groups on the basis of the 12 scales from the In-patient Multidimensional Psychiatric Scale (IMPS) using data from a sample of 787 newly admitted in-patients. For each diagnostic group, a figure was produced containing the Andrews' curves from all the patients in the group. Those groups that were particularly homogeneous or heterogeneous were noted. The main features of the different groups could be discerned.

Two hundred consecutive women from five Southampton general practices who were between 8 and 14 weeks postpartum were visited at home. Each subject was given the 30-item General Health Questionnaire (GHQ-30) and a standardized psychiatric interview. Thirty-seven (18%) were identified as ‘cases’ by the psychiatric interview. Eighty-nine (44.5%) scored highly on the GHQ. Analysis of the results indicates that slight modification of the content and a raised cut-off point of the GHQ-30 make it a useful screening instrument for postpartum psychiatric disorder.

The construction of a short self-report questionnaire identifying social problems, difficulties and dissatisfactions is described. The questionnaire covers housing, occupation, finance, social and leisure activities, child—parent and marital relationships, relationships with relatives, friends, neighbours and workmates, and legal problems. Results of a preliminary testing in a general practice are provided and discussed, and plans for a more comprehensive assessment are outlined.

It is pointed out that the subjects used in psychiatric research experiments are usually drawn in such a way as to invalidate many of the commonly applied statistical tests. The necessarily non-statistical component of any inference is noted, and the area where one might hope for an exact statistical inference is identified. A class of tests permitting such inferences is described. Their theoretical and practical advantages are outlined.

This paper introduces statistical methods suitable for the analysis of response, survival or failure times and, in particular, latencies measured in experiments on the speed of recall of memories. The discussion includes the use of simple descriptive statistics, as well as an explanation of the role of linear-logistic and log-linear models.

In the city of Mannheim the introduction of an extensive community mental health service has been shown, by means of case-register data over 4½ years, to have led to a considerable increase in utilization, mainly at the out-patient level of care. The rates of admission to hospital increased very little. Due to the simultaneous decline in long-term bed occupancy, the overall need for psychiatric beds remained stable at a rate of about 1·2/1000, a rate which is very low by international standards.

The sharp decline in the ‘old’ long-stay population was followed by a smaller increase in ‘new’ long-stay patients which it has not been possible to prevent. These patients are, however, admitted for a long-term stay significantly later than formerly, and their diagnostic composition has changed significantly.

The increase in the bed requirements for short- and medium-term stay patients resulted from different sources: an increasing morbidity in some groups of disorders, the rising utilization in case of emergencies and severe crises, and the transfer of long-stay patients to alternative care services. The level of these needs was very similar in Mannheim, Salford, Samsø and Camberwell, whereas the rates for long-term beds still show clear national differences.

Vasopressin was administered in the form of a nasal spray to a group of 7 head-injured patients and compared with placebo in its effects on intellectual functioning, each patient serving as his own control. No significant differences in performance were found during the conditions of placebo and the active agent.

Serum levels of 7, 8-dihydrobiopterin were significantly raised in female patients with depressive illness who were being treated with tricyclic antidepressants.

This paper discusses methods for assessing speech dominance in cases for unilateral ECT. The use of formal laterality tests has been strongly advocated in the literature, but is seldom adopted in clinical practice. Assessment of handwriting type (left/right, inverted/non-inverted) has been put forward as an alternative, but is not valid. Consideration of handedness alone is the most common practice, but is of little value. From current evidence on the relation of handedness to speech dominance, the paper evaluates the likely outcomes of always administering right-sided ECT, and of giving formal tests to left-handers only.

In a double-blind, placebo-controlled study with co-dergocrine in the treatment of tardive dyskinesia in a group of elderly chronic psychiatric patients the reduction of dyskinetic scores in the group receiving active medication was slightly greater than that in the placebo group; however, this difference did not reach a level of statistical significance. It is suggested that further work could be undertaken with a longer period of treatment, and at a higher dosage level of co-dergocrine, in a younger patient sample.

Groups of elderly people, matched by level of dependency and probability of dementia, were identified in day centres, day hospitals, wards, and local authority homes, and followed up over 9 months to determine the impact of type of care upon outcome. No difference in mortality or changes in dementia scores were found, but the survivors' levels of dependency improved most in day centres and local authority homes. This finding, and the problems of matching, are discussed.