Many psychiatrists assert that an expansion of mental health services in the developing countries is overdue. This will only take place if: (i) the tasks of mental health care are undertaken by a wide range of non-specialist health workers, including those responsible for primary health care; and (ii) services are directed initially at a very limited range of priority conditions. The method of priority selection is discussed, and the process required for translation of priority decisions into health action is exemplified by two illustrations.

Those who were labelled as depressives in a rural survey were randomly divided into a Medicine group (who received antidepressive drug treatment), a Placebo group (who received placebo) and a Natural Process group (who received no treatment). The depth of their depression was assessed by Hamilton's Depressive Rating Scale before the beginning of the trial, on the 14th day and on the 28th day of trial. They were compared with a matched group of healthy controls and again with a matched group of depressives who attended an urban clinic for treatment.

The results indicate that the rural depressives who never sought treatment voluntarily were not different from those who sought treatment in clinics, so far as their response to treatment is concerned.

This retrospective study describes the epidemiology of attempted suicide among Asian (Bangladesh, India and Pakistan) immigrants in Birmingham during the period 1969–1972.

The hypothesis of no difference in the distribution of attempted suicide among native and immigrant groups was not upheld. The immigrant group was under-represented among all the admissions to Birmingham's hospitals. It is estimated that the crude adjusted rates for attempted suicide among the male and female Asian immigrants aged 15–64 years are 57 and 126 per 100,000 population per annum respectively. These are lower than the rates found among natives in Britain, but the female immigrant rate is higher than that found in India.

Asian patients who attempt suicide in India and Birmingham are younger than 45 years of age, rarely abuse drugs and alcohol, and make repeated attempts infrequently. In Birmingham, however, immigrants and native patients swallow similar, mostly psychotropic, tablets and not insecticides as in India. It is noteworthy that an interpersonal dispute precedes attempted suicide more frequently among immigrant patients than among native ones in either area.

The epidemiology of attempted suicide among Irish immigrants in Birmingham is described from data concerning 352 (138 male, 214 female) hospital admissions made during the period 1969 to 1972.

Admissions from the Irish Republic and from Northern Ireland were similarly distributed, but were both grossly over-represented. The average annual rate of admission (222 male, 362 female) was probably higher than the rates in Dublin, Belfast and Edinburgh. The female patient rate (286) was greater than that of Edinburgh, but the male rate (143) was not. Fewer Irish than British admissions gave a history of previous attempted suicide or repeated this attempt. Indices of stress among immigrants were, however, greater. The importance of sociocultural factors is discussed.

This study investigates the reasons people give for taking overdoses of drugs. A representative sample of 128 subjects were interviewed immediately after their recovery from an overdose. During the interview they were given alternative reasons for taking overdoses and asked to choose any that applied to them. Spontaneous comments about suicidal intent were also recorded. Of the subjects, 44 per cent indicated that they had wanted to die. On the basis of their choices 33 per cent were ‘seeking help’, 42 per cent ‘escaping from the situation’, 52 per cent ‘obtaining relief from a terrible state of mind’ and 19 per cent ‘trying to influence someone’. The association between these various reasons and other expected effects or feelings associated with the act were examined by means of multidimensional scaling analysis. In addition, the characteristics of those expressing suicidal intent and other reasons were studied, together with such consequences as toxic effects and psychiatric after-care. The possibility is discussed that a large proportion of those indicating suicidal intent do so either to gain social acceptability for their act or to influence helping agencies.

During 1972–74 nine populations of schoolgirls were surveyed in respect of the occurrence of anorexia nervosa. As well as the current school year, previous years (going back variously 3–6 years) were also carefully studied within seven of the schools. Anorexia nervosa was only identified as present or having been present if the diagnosis was unequivocal: for instance, seemingly evident and severe cases which could not be traced were excluded. The condition in severe form was found to be relatively common in the independent sector of education, probably implying a social class factor. In all such schools, the prevalence was one severe case in approximately every 200 girls. In those aged 16 and over it amounted to one severe case in about every 100 girls. Overall, these schools encountered one ‘new’ severe case in every 250 pupils aged 16 years and over. The condition is likely to be even more common than this study allows because of the stringent limits set here on inclusion of cases and the age-band studied. It is concluded that severe anorexia nervosa is a common condition and is probably getting more common.

A patient is described who developed the classical syndrome of anorexia nervosa at the age of 52. Her illness occurred in relation to the marriages of her daughters and showed an extreme preoccupation with her body shape and a determination to slim by diet, purging and vomiting, and the hiding of food to the extent of rendering herself too weak to cope with the demands of her life.

It is suggested that anorexia nervosa, though predominantly a disease of onset in adolescence, may present at any age and should be considered in the differential diagnosis of anorexia in patients over the age of 50.

Thirty-six patients who had had infectious mononucleosis (IM) were followed up a year later and assessed by the Middlesex Hospital Questionnaire and by interview or (in five cases) by postal questionnaire. The results support the view that IM leads to depression in a considerable number of cases, but in this series only women were so affected.

Among twenty patients with narcolepsy intelligence was normal and no characteristic personality or psychopathology was found. A family history of psychiatric disorder was present in five and a past personal history in ten. Eight had a current psychiatric disorder and twelve either a current or past psychiatric disorder. Chronic sexual disorder was present in eleven. Arousal appeared to be the mechanism by which emotions precipitated symptoms. Ten patients were found to have had difficulties at work, in marriage or in social life.

The efficacy and side effects of 10 mg of nitrazepam and 25 mg of thioridazine as sleeping aids were measured in 20 psychogeriatric in-patients during the 14th night and morning of drug administration. The trial used a double blind, cross-over design. The effect of nitrazepam was slightly faster than that of thioridazine. After thioridazine, but not after nitrazepam, the patients slept significantly longer than after placebo. Nitrazepam, but not thioridazine, significantly impaired patients' abilities to move and to conduct everyday activities. It is concluded that thioridazine is a suitable sleeping aid for psychogeriatric patients, but that nitrazepam should be avoided.

In 1970 we studied the phenomenon of rejection in two units of a psychiatric rehabilitation hospital (Morgan and Cheadle, 1972). The study concluded that 20 patients out of a sample of 110 were rejected to some degree by some members of staff. The method employed to determine this was to ask all members of staff to name the patients who they considered fitted into certain categories. Ten of these categories indicated desirable behaviour such as helpful, co-operative or appreciative; the other ten were of an undesirable nature such as lazy, untrustworthy or attention seeking. The questionnaire used was published as the Appendix to our previous paper. If a staff member placed a patient into more undesirable than desirable categories he was considered as rejecting that patient. If more staff rejected a patient than accepted him, the patient was considered to be a reject.

The paper is concerned with methodological problems relating to the scientific study of the effectiveness of Alcoholics Anonymous (AA). Studies of the effectiveness of AA fall into two categories—longitudinal and cross-sectional, and may be criticized on the basis of over-simple criteria of success.

The particular problems of the requirement for control groups in studies of effectiveness are pointed out. The problems arising out of the whole process of affiliation and disaffiliation and their implications for scientific study are discussed. The requirement for sound statistical analysis is stressed, and inadequacies in the techniques of follow-up are indicated.

The studies which have some bearing on AA as a treatment facility are reviewed. These include multivariate studies involving AA attendance as one factor, studies in which AA was the main variable in a hospital programme, and longitudinal studies of AA from within the organization. Particular difficulties in using cross-sectional surveys for the purpose of estimating efficacy are pointed out.

The conclusion reached is that because of the methodological difficulties the totality of these studies does not add significantly to the knowledge concerning AA which we possess from clinical experience. Moreover, without a change in the unusual characteristics of AA when considered as a treatment facility it seems unlikely to be possible to assess its effectiveness in a scientific manner.

A therapeutic group with eight members was studied, using psychometric tests, improvement ratings based on pre-treatment statements of patients' hopes, and of therapists' aims rated for achievement on the basis of post-treatment interviews, and two forms of repertory grid testing. The In-Group Grid yielded a number of measures relating to outcome and to aspects of the group process. Most patients improved by some criteria, and most measures of improvement intercorrelated positively but not, in most cases, highly. Few clear relations between process and outcome measures were demonstrated.

According to the medical model of the disease concept, a class of patients is homogeneous only when it is characterized by manifestations which have their ultimate intra-organismic origin in a particular kind of physiopathological cause. Most patient classes are still heterogeneous because we are still ignorant of that cause.

The medical model can be applied to the subdivision of all classes of patients, including classes of non-organic psychiatric patients. However, the successful application of the medical model depends on the acquisition of knowledge of relevant physiopathological facts. It is argued that the dimensional model of evaluating psychological abnormalities is not likely to help in acquiring that knowledge.

The Symptom-Sign Inventory was administered to 57 long-stay psychiatric in-patients with the object of selecting a group of questions which would stimulate the production of delusional or other psychotic material. The scoring of the responses as positive was made on verbal affirmative and other specific behaviours which were thought to indicate emotional impact. It was found that the ten questions selected compared favourably with longer questionnaires in discriminating schizophrenic from normal subjects and from those with organic brain disease. It is suggested that these questions might be included in brief assessment interviews on which day-to-day management decisions are made.

An inquiry was made of all women senior registrars in general psychiatry who were known to be planning to remain in psychiatry in this country. Most were hoping to work full or maximum part-time, and all except one were aiming for a consultant appointment in general psychiatry or one of the specialties. Many anticipated difficulties in realizing their ambitions because of being tied to one particular area on account of their husbands' employment. A number of solutions to this problem are suggested.