Objective: To describe the characteristics of “new” long-stay patients in a district general hospital psychiatric unit. Method: A “new” long-stay patient was defined as a patient aged 18 or more who on the census date had been in a district general hospital psychiatric ward for longer than six months but less than six years. There was no upper age limit but patients with a primary diagnosis of dementia were excluded from the study. Information about each patient was obtained from medical and nursing cases notes. Patients were interviewed by one interviewer to determine their views on discharge from hospital. All the members of the multi-disciplinary team were interviewed by one interviewer to obtain their judgements about future accommodation needs of the patients. Results: “New” long-stay patients are typically single in their mid-forties with no supportive relatives. Most have a primary diagnosis of schizophrenia. They have a long psychiatric history and the majority had been in hospital between 6 months and three years. The principle reasons for prolonged stay were persistence of active psychotic symptomatology, schizophrenic defect state, poor social skills and antisocial behaviour. Conclusion: A group of “new” long-stay patients have accumulated in Wolverhampton district general hospital psychiatric unit, despite modern methods of treatment and the availability of a good range of rehabilitation facilities. They are a diverse group including patients with a severe schizophrenic disorders, affective disorders, personality disorders and organic disorders. Ideally, if these patients are to be placed in the community, rather than remaining as inpatients, then placement would need to be in specialised facilities like hospital hostels.

Clozapine (Clozaril-Sandoz) is an atypical anti-psychotic drug used for the treatment of resistant schizophrenia. We describe the first fatal outcome as a consequence of neutropenia in the British Isles attributed to the use of clozapine. This death occurred despite proper monitoring by the Clozaril Patient Monitoring Service (CPMS) and full clinical vigilance.

Bipolar affective disorder has a usual age of onset in early adulthood. Adolescent onset occurs in some, prepubertal onset in a few. Early onset affective psychosis in two generations is rarer still and provides powerful evidence for a major genetic effect, especially where adoption removes confounding environmental stresses. We present just such a case in a mother and her daughter.

Objective: General practitioners play a crucial role in the delivery of psychiatric treatment to patients who have many similarities to those attending the general psychiatric services. The purpose of this study was to elicit attitudes of general practitioners to an existing local service. Methods: We used an anonymous questionaire hand delivered to 54 general practitioners with practices in the catchment area of one of Dublin's psychiatric hospitals. Results: We received responses from 40 of the GP's indicating a high level of psychiatric morbidity in the primary care setting, a moderate level of satisfaction with psychiatric service, a low level of knowledge of the catchment area system, limited interest in taking on an increased role in the care of psychiatric patients and a high popularity rating for the community psychiatric nurse. Conclusions: This study confirms previous estimates of psychiatric morbidity in general practice, a need for improved communication between psychiatrists and general practitioners to identify more realistic expectations on both sides of the equation, and a huge potential for the expanding community psychiatric services to improve liaison between general practitioners and psychiatrists and yield considerable patient and doctor gains.

John Conolly [1774 - 1866] was born at Market Rasen into a collateral branch of the prominent Castletown, Co. Kildare, family. After graduating at Edinburgh in 1821, his efforts in clinical practice, bolstered by indifferent forays into medical journalism, were repeatedly unsuccessful. Thus, at the age of 45, over the course of four years as Resident Superintendent of Hanwell Asylum in Middlesex, he became one of the leading psychiatrists in England. Though his consulting practice blossomed thereafter, it is as the consummate, kindly administrator responsible for the introduction of non-restraint in public asylums in England and Wales that he is remembered today.