The effects that mentally ill people have on their families have been more commented upon than studied. The currently favoured practice of community care has increased the need for a systematic attempt to evaluate the families' problems, and an opportunity to do this occurred when a community psychiatric service was introduced in Chichester in 1958, while the neighbouring Salisbury district continued with a conventional hospital-based service. The Medical Research Council's Clinical Psychiatry Research Unit has been evaluating the new service to find out how it affects referral and admission rates; how it influences social and clinical outcome, and the effect it has on the community itself. As the patient's family is the sector of the community most closely concerned in any extension of the extra-mural care of patients, we began by assessing the effects on them. The present paper therefore describes the assessments we made of the burden the patients' families carried in the Chichester Community Care Service and compares their burden with that experienced by families in Salisbury, where admission to hospital was more commonly practised. The comparison is made in terms of the relief that was afforded the two groups of families over a period of two years.

In recent years, a number of surveys of attempted suicides have been reported (Middleton et al., 1961; Sclare and Hamilton, 1963; Parkin and Stengel, 1965; Whitlock and Schapira, 1967). Other studies (Kessel, 1965; Oswald, 1966) have shown that the number of cases of attempted suicide has greatly increased in the last decade. Apart from one survey from Tasmania (Gold, 1965), all these have come from large urban or industrial communities.

There is no uniformity in the use of the terms habituation, addiction, intense desire, and craving. V. Petran (19) talks of craving as the irresistible desire to acquire a drug and the impossibility of abstaining from it. Craving may be manifested immediately after first consumption, but addiction represents a regular use, from which craving may develop in time.

With your permission I should like to try to give this address the pattern of a clinical demonstration: analysing a given set of problems, “a case”, and reasoning from the particular towards the general, so that the case under consideration may open the way to wider understanding.

The present work is a study of the distribution of chromosomes in female patients with senile dementia and in two control populations, one the same age group and one below the age of 40.

Recent workers investigating psychological dysfunction in schizophrenic patients have stressed the fact that such patients appear to have some specific difficulty in speech perception. It has been claimed that schizophrenics require more cues in order to reproduce verbal material accurately. This disability has been analysed by methods inspired by the work of communication engineers.

The ability to interpret the meaning of metaphorical proverbs has been used not only in intelligence testing but also to investigate abnormalities of thinking in schizophrenia; mainly the theories that schizophrenics are either “concrete” or “overinclusive” in their thinking. The theory of concreteness has been proposed mainly by Goldstein (1946), who held that schizophrenics were unable to adopt the “abstract attitude”, and, having lost the ability to form normal abstract concepts, formed concrete ones instead. Cameron (1946) described overinclusion as one of several abnormalities found in schizophrenic thinking. This abnormality has been adopted by Payne and his co-workers (1957, 1959, 1960, 1962, and 1966) as the basic disorder of schizophrenic thinking. Schizophrenics showing this disorder appear unable to maintain the boundaries of a problem, and so form overbroad concepts. Overinclusion, however, is found in only about 50 per cent. of acute schizophrenics and has also reported in other psychiatric conditions (Payne and Hirst, 1957; Payne and Frielander, 1962; Sturm, 1965).

The results of a comparative trial of desensitization and psychotherapy for phobias have been reported (Gelder, Marks and Wolff, 1967). Desensitization was found to have a rapid and rather specific effect on phobic symptoms, which was followed by improvement in social adjustment. During group and individual psychotherapy, phobias and other symptoms changed more slowly and social adjustment often improved without any corresponding improvement in phobias. At the end of the investigation the phobias of 14 of the original 26 psychotherapy patients had shown no worthwhile improvement. Six months later, another follow-up showed that 5 had improved further, leaving 9 still unimproved. It was decided to try the effects of desensitization with these patients, particularly in view of a finding by Lazarus (1961) that desensitization helped patients who had not responded to a very brief form of group psychotherapy. As Lazarus worked with volunteer subjects rather than psychiatric patients, and as his “group therapy” averaged only eight weeks, his finding required confirmation before it could be applied to psychiatric patients.

References to compulsive gambling are found in the psychiatric literature as early as 1914 (von Hattingberg) and 1920 (Simmel). These and subsequent literature on the psychodynamics and treatment by analytical methods were summarized by Harris in 1964. In the past year references have been made to the treatment by aversion therapy of isolated cases of horse race gamblers and of a “one-armed bandit” gambler (Barker and Miller, 1966b, Seager et al., 1966, Barker and Miller, 1966a). A further case of a compulsive horse race gambler treated by aversion therapy seems worth presenting, in view of the sparse literature on treatment of the condition by this method, and also because in this case, the therapy was immediately followed by remission of a longstanding marital disharmony which is believed to have been one major precipitating cause of the gambling.

The present paper reviews six years of operation of I.T.O. (Bristol) Limited, during which there were 605 referrals. The majority came from Glenside Hospital, 374 patients (62 per cent.), and approximately 8 per cent. were referred from each of the following sources—Local Authority, Day Hospitals, Hospitals for the Subnormal, other psychiatric sources and non-psychiatric sources. Male admissions totalled 326 (54 per cent.) and female 279 (46 per cent.): of these only 84 (14 per cent.) were married with a surviving partner and 492 (81 per cent.) had never been married.

The need for an acceptable, effective non-barbiturate hypnotic has long been recognized. Nitrazepam (Mogadon), an analogue of chlordiazepoxide with a chemical formula: 1,3-dihydro-7-nitro-5-phenyl-2H-1,4-benzodiazepin-2-one recently became available for trial. It has been reported to be a safe and effective hypnotic (General Practitioner Research Group, Report No. 79, 1965). Peck and Shervington (1966) found 10 mg. of nitrazepam as effective as 200 mg. of amylobarbitone in general hospital patients. In a previous investigation (Haider, 1967) I reported the efficacy of nitrazepam as an hypnotic agent, in comparison to a placebo, in a group of elderly psychiatric inpatients.

Gilles de la Tourette's syndrome is an unusual condition with undetermined aetiology, treatment, and prognosis (1, 2, 3). Less than 50 case studies have been reported in the literature. This paper will present a detailed report of a case treated for 18 months, and brief summaries of two cases treated for three weeks.

Methohexitone sodium (Brietal, Brevital), an ultra-short-acting barbiturate, has recently been introduced as a method of relaxation in behaviour therapy (Friedman, 1966; Brady, 1966). It appears to be safer than thiopentone (Pitts et al., 1965), and has the added advantage that the recovery time is quicker (Jolly, 1960). The present report refers to two patients suffering from premature ejaculation who were successfully treated by systematic desensitization using methohexitone.

It has long been recognized that chronic brucellosis may present as a psychoneurotic illness, and this is well emphasized by Spink (1963) in Cecil and Loeb's Textbook of Medicine. However, presentation in the form of a psychosis is rare, and this is not mentioned in Spink's article, nor in a standard psychiatric textbook such as Mayer-Gross, Slater and Roth (1954). Dalrymple-Champneys (1960) described a series of 1,500 cases of brucellosis; only two of his patients had delusions and hallucinations. Hobbs (1931) described the case of a woman of 56 who developed delusions of persecution and believed her food to be poisoned. This latter symptom was also shown by one of the patients in Dalrymple-Champneys' series, and the same complaint occurred in my patient. Although a very rare cause of paranoid illness, the recognition of brucellosis is important so that appropriate treatment can be instituted.