Although day care for the mentally ill has been used for almost forty years the potential of the service has not been fully utilised and the movement lacks any sense of overall direction. Day hospitals, the major provider of day care places, have expanded because of practical and financial pressures rather than by their own merit. Meanwhile, day centres have failed to make any significant impact on the psychiatric system, due to a lack of funding to local authorities and their consequent lack of commitment. The result has been a rather ad hoc development of services and a failure to rationalise their activities.

Although recent research in social psychiatry has produced an encouraging congruence of findings and conclusions, puzzling inconsistencies continue to be reported. One explanation which is often overlooked is that subtle differences in the way seemingly identical variables are grouped can produce sizeable, and sometimes dramatic, differences in the patterning of the same data. Re-examination of existing results can therefore often better clarify confusing inconsistencies than collection of new data. This is illustrated by examples from recent studies of affective disorder where the grouping of variables is discussed in three broad areas: parental loss in childhood, precipitating stress, and social support. Until the aetiology of affective disorder is more fully understood, it will often be clearer if data are analysed more than once, so that several combinations of variables are systematically examined.

L-5HTP and tranylcypromine were compared in an open, but controlled and cross-over study, in patients suffering from major depression; all were non-responders to several reuptake inhibitors, including oxaprotiline and fluvoxamine. After four unsuccessful sleep-deprivations, L-5HTP or tranylcypromine were given during four weeks in a crossover design. Of 17 patients given L-5HTP during both treatment periods, none responded, whereas of 26 patients treated with tranylcypromine, 15 responded. Thus, L-5HTP is not a therapeutically effective alternative in depressed patients who have not responded to reuptake inhibitors.

Platelet α2-and lymphocyte ß2-adrenoceptor densities, plasma noradrenaline and serum Cortisol were measured before, during and one week after a course of EEG-monitored electroconvulsive therapy, in nine depressed patients. A 50% fall in Hamilton Depression Rating scores occurred after a fairly consistent total seizure time, regardless of the amount of ECT given. Platelet α2-adrenoceptor densities showed a statistically significant fall after three ECTs, but were unchanged after the full course of ECT and were independent of clinical change. Lymphocyte ß2-adrenoceptor densities were unaltered. Plasma noradrenaline concentrations were initially high, and fell with ECT in a manner paralleling clinical recovery. Plasma noradrenaline may be a more useful index of central changes during antidepressant treatment than peripheral blood cell receptor densities.

Thirty-six patients with a primary depressive illness, admitted consecutively to hospital, were studied. All patients had a pre-treatment DST, followed by weekly DSTs during a six-week treatment period. Three categories of DST response were identified, on the basis of the serial DSTs. All three groups showed improvement with treatment: the two non-suppressor groups showed normalisation of the DST over the treatment period, but only the normalising non-suppressors showed a significant correlation between DST normalisation and clinical improvement.

Twenty psychiatric in-patients were studied before and after five bilateral electroconvulsive treatments for major depression. There were significant memory and neuropsychological changes after treatment, and significant reductions in depression rating scores, but they did not correlate with various measures of blood pressure elevation during treatment. The importance of ECT-related amnesia is discussed.

The age-standardised rates of first-ever alcohol-related diagnoses amongst both general hospital in-patients and psychiatric referrals were examined in the Grampian region from 1974 to 1982. Male general hospital admissions in this category rose steeply from 1974 to 1978, but then declined steeply thereafter; it is concluded that this may reflect a beneficial effect on male drinking habits as a result of the liberalisation of Scottish licensing laws. The remaining data supported the belief that the gap is narrowing between male and female rates of alcohol-related illness.

Some hypotheses about the cause of schizophrenia are based on the puzzling tendency for mental illness to affect the same sex when two close relatives become psychiatrically ill. Sex-concordance rates were examined in 71 schizophrenic probands, who had at least one first-degree relative suffering from the same disorder, in order to test this tendency in a population of recently admitted patients. No unusual concordance rates were found when unaffected sibs were taken into account and relatives were stratified to take account of possible confounding factors. It would seem premature to construct hypotheses about the aetiology of schizophrenia based on evidence of this type.

Substantial evidence suggests that genetic factors contribute to the aetiology of both schizophrenia and alcoholism, when they occur alone. To examine the role of genetic factors in schizophrenia and alcoholism when they occur together in the same individual, the frequency of both conditions was investigated in the co-twins of 34 monozygotic (MZ) and 47 dizygotic (DZ) index twins with a diagnosis of both schizophrenia and alcoholism. Both disorders alone were significantly more common in the MZ than in the DZ co-twins, suggesting that individuals suffering from schizophrenia and alcoholism have a genetic predisposition to both disorders, which is of the same nature as that which causes the two when they occur alone. In the co-twins of the MZ index twins, the diagnoses of schizophrenia and alcoholism were uncorrelated, indicating that the specific environmental factors of causal importance in the two disorders are not closely related.

When male alcoholics with and without a positive family history were compared, differences were found in age of onset, age of presentation, severity of alcoholism, and severity of self-reported antisocial behaviour. No such differences were found for women. The implications of these findings for the concept of ‘familial alcoholism’ are discussed.

In a group of 23 hospital patients aged over 50 with Down's syndrome, psychological testing indicated that significant intellectual deterioration, which was un-related to chronological age, sex, length of hospitalisation, or earlier mental age, had occurred in nine. Clinically, there was no evidence in any patient of active physical illness, focal neurological signs, or dementia, but significant associations were found between intellectual deterioration and decreased visual acuity, hearing loss, and macrocytosis.

Computed cranial tomography was performed on 48 patients with Senile Dementia of the Alzheimer Type (SDAT) who have since been followed up in a continuing prospective study. At six-months follow-up, ten patients had died; these did not differ significantly from the survivors either in mean age or duration of dementia, although the latter tended to have been shorter in the deceased. Despite having shorter histories, the deceased had performed worse on initial testing with several cognitive measures, and this was significant for the mental test score; this suggests some patients may have a more rapidly progressive form of SDAT. In a comparison between the CT scan of the deceased and survivors, the deceased were found to have significantly lower mean attenuation densities in the parietal, occipital, and left thalamic regions. The hypothesis that low attenuation density in the parietal regions of the CT scan in SDAT is associated with a more rapid demise is supported for the present period of follow-up.

Seven cases of nightmare were treated by simple rehearsal of the nightmare and/or rehearsal with an altered ending, followed by earlier introduction of the ending. One-year follow-up of five patients showed complete relief from nightmares in the four patients who achieved early introduction of a ‘masterful’ ending, and marked improvement in the patient who could only imagine a neutral ending. All but one of the patients also presented with neurotic symptoms (anxiety, phobias, depression and compulsion/obsession). These were treated by rational discussion and the formulation of positive ‘threat-eliminating’ statements to be repeated as homework and in times of stress.

The mid-life period is regarded as a period of profound physical and psychosocial change for women. Psychological disturbance at this time has been associated with discrete life events. The influence of other psychosocial variables on psychological disturbance is examined in a general population sample. Five psychosocial variables are shown to have a relationship with psychological disturbance, either in conjunction with or independently of life events. The implications of these findings for the understanding of psychological disturbance at this time are discussed.

Fifteen cases meeting the diagnostic criteria for presbyophrenia are reported and compared with a control sample of patients suffering from dementia. The presbyophrenic patients exhibited more elevated mood, more hyperactivity, more disorientation, and had lower information scores than the controls. Traditional explanations of ‘presbyophrenic behaviour’ such as delirium, pathoplastic effect of personality, or superimposed cerebrovascular disease are not adequate. Instead, presbyophrenia may constitute a sub-type of dementia characterised by severe atrophy of the locus coeruleus, marked impairment of noradrenergic transmission, and uninhibited behaviour.