An account is given of an active treatment programme at a Canadian Provincial Mental Hospital. This programme was designed to reintegrate institutionalized patients, mainly schizophrenics, into the community.

In previous papers (Pilowsky, Levine and Boulton, 1969; Pilowsky and Boulton, 1970; Pilowsky and McGrath, 1970) we have described the development of a depression questionnaire and its use in the classification and identification of depressed patients. In order to increase the flexibility of the questionnaire as a research tool we have derived a depression scale from the items in it and have investigated its validity as a measure of the depth of depression. The purpose of this paper is to describe the development of the depression scale and report the results of validation studies.

During World War II psychiatric screening to exclude ineffective soldiers from active duty consisted of interviews of three to six minutes duration. These interviews were described as successful by Bloomberg and Hyde (1), and by Leavitt (2). But six years later Bloomberg admitted that induction screening had proved ineffective, and suggested continuous observation for the first six months of military service to separate those who would adjust from those who would not (3). This concept of prolonged observation was supported by the wartime findings of Egan et al. (4) and Aita (5). Egan's group examined the records of 2,054 men who had been psychiatrically rejected on the basis of a short interview, but who later served; 79.4 per cent rendered satisfactory service. Aita's five-year follow-up showed that of 100 soldiers considered borderline on interview 21 per cent failed to render satisfactory service and of 100 considered satisfactory 5 per cent failed. If the questionable risk hundred had been rejected the Army would have lost 49 average and 30 outstanding soldiers. It seemed, therefore, more profitable for the Army to risk retaining ineffectives than to attempt to weed them out completely on the basis of brief psychiatric interviews.

Studies on the relationship between physical constitution, personality and mental illness have been mostly confined to the Caucasian race. There has been no investigation, to our knowledge, of Oriental subjects, though a number of investigations of body type, composition and physiological functions without relation to mental aspects have been carried out on them. It is clearly important that work in this field should be extended to include subjects of different racial composition and socio-cultural background. The intercorrelations found between physical and mental characteristics in Caucasians may not apply to others.

Acute dystonic reactions, including oculogyric crises, were once thought to be pathognomonic of encephalitis lethargica, but the clinical use of the phenothiazines has led to the recognition that similar symptoms can be produced by these drugs. Some phenothiazines, such as trifluoperazine, fluphenazine, prochlorperazine and perphenazine (Ayd, 1960; Christian and Paulson, 1958; Hollister, 1957; Waugh and Metts, 1960), are thought to cause these effects more frequently, especially when given parenterally. Other non-phenothiazine tranquillizers, for example haloperidol, also produce these reactions. not un-commonly. Certain patients, particularly the young and perhaps the genetically predisposed, are more likely to be affected.

The Netherne Resettlement Unit, established in 1957, has been described in detailed publications including those by Bennett et al. (1) and Folkard (15, 16). These authors stressed the Unit's dual function of assessment and preparation of disabled patients for resettlement, and described results of its first two years in terms of discharge, readmission and employment. The basic Unit aims of resettlement in optimum employment and accommodation have remained unchanged since that time. The programme has been geared towards minimizing the patients' handicaps by improving their coping abilities (24) so that they can manage in less protected situations, by utilizing the pooled experience of a multidisciplinary rehabilitation team (18) and by mobilizing community resources (36). Hospital living and working conditions are repeatedly scrutinized so that factors which might provoke, increase or reactivate the patients' symptoms (10) are reduced. The Unit's policies, therefore, remain dependent on the forward-looking hospital administration which has encouraged democratization, effective communication and clear definition of function (33).

In a previous report records were studied of 256 in-patients who were discharged as undiagnosed, i.e. in-patients who at the time of discharge did not have a definable psychiatric illness (Welner, Liss, Robins and Richardson, 1972). In that study it was shown that when rigorous criteria for psychiatric research (Feighner, Robins, Guze, Woodruff, Winokur and Munoz, 1972) were used 68 per cent of these patients met the criteria for an established psychiatric disorder. It was concluded that: (1) The chart review diagnoses for a population of undiagnosed patients consisted of a variety of established psychiatric disorders and the population was not homogeneous. (The chart review diagnosis is a diagnosis obtained by review of the patients' hospital records and evaluating the information by using diagnostic criteria for psychiatric disorders.) (2) The most efficient way to arrive at a diagnosis was by structured rather than conventional narrative interview. This study is a follow-up study of these patients and attempts to evaluate the validity of the chart review diagnosis. A concordance between the chart review diagnosis and follow-up diagnosis supports the above conclusions. The follow-up study also served to establish diagnosis in patients who had too few symptoms initially to meet the criteria for a diagnosis.

Erythropoietic Protoporphyria (E.P.P.) may be classified along with the other erythropoietic syndromes of porphyria. It is inherited as an autosomal dominant (Taddeini and Watson, 1968). The condition was first clearly delineated by Magnus, Jarrett, Prankerd and Rimington (1961). They recorded a case with the presenting symptom of solar urticaria in whom faecal excretion of coproporphyrin and protoporphyrin was greatly increased while urinary porphyrins were normal. The red cells contained grossly abnormal amounts of protoporphyrin and coproporphyrin, the plasma increased levels of protoporphyrin. The absence of uroporphyrin distinguished this condition from congenital porphyria (Gunther's Disease).

The present study describes certain characteristics of an in-patient population of newly-admitted patients at the only psychiatric hospital (approximately 3,000 beds) serving the two million inhabitants of Jamaica.

The diagnosis of hysteria has seemed a hazardous one since Slater (1965) pronounced it ‘not only a delusion but also a snare’. His conclusion was based on the demonstrable fragility of the diagnosis when usually accepted criteria are used. Against this, Guze (1967) has put forward evidence which suggests that when his criteria are applied the diagnosis is a stable one. Lader and Sartorius (1968), in a study of 10 patients, also seemed to show that those with conversion hysteria were a single group on the criterion of their failure to habituate to 20 repetitions of a standard stimulus, a disability which distinguished them from other neurotic groups. Slater, however, in criticizing the Perley and Guze (1962) concept, remarked that two residual groups, rather than one, remained as diagnostically unchanged in his 10-year follow-up.

The difficulties in providing adequate psychotherapy facilities in the N.H.S. are well known, and various psychotherapeutic techniques have been used to try to cope with them. Of these the most important have been variants of group and brief psychotherapy, and it is with the latter that this paper is concerned. The technique I have used in this series is to offer patients once-weekly psychotherapy for a maximum period of 6 months and then to terminate no matter what progress has been made, the patient having been informed of these conditions from the start. In this paper I shall consider the criteria used in the selection of patients, the technique and probable mode of action, a brief account of the cases with the therapeutic results obtained, and the follow-up on these cases.

The history of in-patient units for the psychiatric treatment of children in the United Kingdom is largely confined to recent years. Their number is now slowly expanding, and there are approximately 60 in-patient psychiatric units for children and adolescents (R.M.P.A. 1970; Department of Health and Social Security, 1970).

Over 70 years ago, Sibbald (1900) commented that the official statistics on suicide showed Scotland to have lower rates than England and Wales. It seems that Scotland has always been regarded as one of the countries with relatively few suicides. A recent World Health Organization publication (1968) commented on the official suicide rates in a sample of 20 different nations; among these Scotland ranked nineteenth in 1952–4. However, this picture appears to have been gradually changing over the last two decades, and the same W.H.O. publication, citing official statistics for the period 1961–3, quotes a value for Scotland which raises it to fifteenth in the list of 20 countries. Moreover, the Scottish rates and those for England and Wales have gradually come closer together over the last 20 years.

The aim of this paper is to examine the trends in Scottish statistics for the last two decades and to compare the current suicide rates with those of the rest of the United Kingdom. All the data quoted are based on the publications of the Registrars General for Scotland and for England and Wales.

Notwithstanding Hamilton's remark that childbirth is responsible for a great deal of neurotic illness, the literature is heavily weighted in favour of studies of puerperal psychosis, even though this condition occurs in only one in a thousand births. Since the milder forms of illness tend to pass unrecognized they are often responsible for stress in the individual and family; thus it is right and proper that more attention has recently been paid to these. Pitt (1968), for example, found an incidence of 10–17 per cent of atypical depression and psychosomatic illness that persisted for several weeks and in some cases for as long as one year following childbirth. Between normality and psychotic or neurotic illness lies the mild affective disorder that so often characterizes pregnancy and the early Puerperium, but does not amount to an ‘illness'. Perhaps because women regard it as an expected hazard from which they will recover it has not generally been considered to merit serious study. Jarrahi-Zadeh et al. (1969) looked at this and found that as many as 55 per cent had one or more depressive symptoms during pregnancy. If anything it was less common post-partum, and they furnished evidence for a brain syndrome of mild degree occurring at this time. Yalom et al. (1968) have described the post-partum blues syndrome as occurring in 66 per cent of their subjects and hold it to be a self-limiting condition of only a few days duration. It is likely that patients with the blues have a greater risk of developing a neurotic depression, which might reflect upon personality factors, but the same cannot be said to hold for post-partum psychosis.