Duration of stay for unselected admissions to an acute psychiatric ward was reduced to an average of 11 days. The clinical methods by which this was achieved are described. Comparing patients randomly allocated to this experimental ward and other admission wards: (i) the readmission rate to the experimental ward was higher but readmissions were briefer so that total in-patient experience per patient over the course of one year remained substantially lower; (ii) symptom levels and burden on the family had improved equally at three weeks and at four months after discharge; (iii) experimental ward patients made fewer demands on their general practitioners and reported fewer parasuicides. Beds can be released for other purposes in this way.

This study of violent behaviour among psychiatric in-patients in three hospitals found that many incidents of petty violence occurred and serious violence was rare. Among the offending patients there were more females than males, more young than old and the most commonly represented diagnosis was schizophrenia. Nursing staff were by far the commonest victims. Most of the incidents occurred during the daytime and were perpetrated mainly by patients nursed on acute psychiatric wards. The vast majority of patients were nonviolent.

In 1976, 163 patients were approved by the Department of Health and Social Security for transfer from the Special Hospitals to the open wards of the National Health Service. By autumn 1978, a quarter were still waiting for admission. Patients meeting most difficulty were the severely handicapped non-offenders, who were usually refused unseen on the ground that local subnormality hospitals were full. The role of the DHSS and of the Regional and Area Authorities was in general restricted to bewailing problems they could not help to solve.

Some two years after their transfer, enquiries were made in the NHS about the 105 transferred patients. Removal back to the Special Hospital had been requested for seven, and another three had been removed by the police and prosecuted.

Kinetic analysis of the transport of 5-HT into the blood platelets of depressed patients and recovered depressive patients has shown that the rate of accumulation of 5-hydroxytryptamine (5-HT) is significantly decreased both before and after recovery from the illness. This abnormality is corrected by both short and long-term lithium treatment. As a corollary to these studies, the effect of lithium in vitro on 5-HT uptake has been studied and the results are opposite to those reported in vivo. These findings suggest that lithium acts indirectly, and possible mechanisms of its action are discussed.

Causes of death were studied in a cohort of 200 schizophrenic, 100 manic, and 225 depressive patients who were followed in a historical prospective study. These patients were admitted between 1934 and 1944 and were studied 30 to 40 years later. Five cause of death categories were considered in this analysis: (1) unnatural deaths, (2) neoplasms, (3) diseases of the circulatory system, (4) infective and parasitic diseases, and (5) other causes. For each cause of death, the expected number of deaths was calculated from vital statistics for the State of Iowa for the time period of follow-up. Observed numbers of deaths were contrasted with expected numbers of deaths to assess statistical significance for each diagnostic group. There was a significant excess of unnatural deaths in all diagnostic groups in both sexes, with the exception of female manics. This group, however, did show a significant excess of circulatory system deaths. Both male and female schizophrenics showed a substantial excess of infective disorder deaths.

A survey of 14 published studies found no consistent association between specific HLA antigens and schizophrenia. Since these studies lacked diagnostic or biological criteria, an investigation was undertaken using recognized diagnostic criteria and CT scan findings. Typing for HLA antigens at loci A, B and C was carried out on 130 patients. Among 92 black schizophrenic patients there was an increase of HLA-A2 which remained significant even after correcting for the number of antigens studied. When the patients for whom CT scans were available were divided according to the presence or absence of evidence of brain atrophy, there was an increase of A2 in the black schizophrenic patients without evidence of atrophy, which remained significant after multiplying by the number of antigens studied. However, there was no significant increase of A2 in those with evidence of atrophy. Similar trends held for the white population but they failed to reach significance. The need for HLA studies on biologically defined groups of schizophrenic patients is stressed.

Computed tomographic (CT) and brief psychometric findings on 50 psychiatrically and neurologically healthy community residents over 60 years old are presented. The need for normative CT data is emphasized, and the methodological problems in obtaining them are discussed. Measures of ventricular size were generally found to be greater than those reported by other workers, and variation with age was also found to be less marked than hitherto reported. A reciprocal relationship was found between a global rating of cortical atrophy and a test of memory and orientation. This communication forms the basis for comparison with groups of psychiatric patients to be presented in subsequent articles.

Clinical, psychometric and computed tomographic (CT) data are presented on three groups of elderly subjects: 50 normals, 40 patients with senile dementia and 41 suffering from affective disorder. Demented subjects showed significantly more CT evidence of cerebral atrophy than non-demented subjects, but there was considerable overlap. Although patients with a history or clinical signs of cerebral infarction were specifically excluded, such infarcts were found more often in CT scans of the dementia subjects than in the others, particularly when the diastolic blood pressure was raised. When correlating cognitive impairment with CT changes, ventricular size emerged as more important in the dementia patients, in contrast to the controls, in whom cortical atrophy was related to lower scores on a cognitive test. Other interesting findings included an inverse relationship between cortical atrophy and paranoid delusions.

Clinical and computed tomographic (CT) data on a consecutive series of 41 elderly patients with affective disorders are presented, and comparisons made with a group of 50 healthy controls. In both groups ventricular size increased with age, but only in the controls was there an age correlation with sulcal widening. Using clinical and radiological criteria, the prevalence of cerebrovascular disease in the patient group was 12 per cent. A sub-group of patients with enlarged ventricles emerged, whose first depression began later in life, and who at the time of this study were older and showed more ‘endogenous’ features than the remainder. It is suggested that this provides further evidence that organic cerebral factors may have aetiological significance in some depressions of old age.

One hundred consecutive referrals to a general medical out-patient clinic were evaluated psychiatrically under blind conditions in order to investigate the nature and occurrence of non-organic disease presenting as gastrointestinal illness. Twenty-eight patients had marked psychiatric illness with or without physical illness, and there was an association between psychiatric illness and the absence of organic disease, as determined by outcome at follow-up of 4–11 months. Patients with obsessional traits were more at risk of non-organic illness. Historical items indicating a likelihood of non-organic gastrointestinal illness included ‘nerves', ‘depression’, unhappy childhood, early parental loss and early separations from parents during childhood. Psychiatric illness often persisted after treatment for physical symptoms. Some of the techniques used in this study to identify psychiatric illness could be usefully employed in everyday practice.

Three patients experienced complex formed hallucinations during progressive visual failure from eye disease. The hallucinations began abruptly, were brightly coloured stereotyped figures, animals or objects, and appeared to be provoked by light.

As blindness progressed the clarity, frequency and duration of the hallucinations faded. The patients had no abnormalities other than their eye disease, which in two cases was macula degeneration, and choroideraemia in the third.

Seventy-four overweight psychiatric in-patients were treated with weight reducing diets for periods varying from 6 months to 34 months. Seventy per cent lost weight and 18 per cent attained an ideal weight. Weight reducing diets should be considered an important aspect of treatment for the majority of obese patients in psychiatric hospitals regardless of the cause of obesity.

Personality variables and psychiatric symptoms were each assessed by inventory in 42 patients with anorexia nervosa: as in-patients initially, and during a three-year follow up. The results were used to distinguish primary from secondary cases and to monitor the clinical progress of the disorder.

In an article entitled ‘The Nasal Drop Addict’, Jarvis (1969) wrote, “Every rhinologist from time to time sees patients who are using decongestant drops every few hours in an effort to obtain a clear nasal airway”. Yet few reports have appeared in the medical literature.

The scope of psychosomatics would appear to be almost limitless, thus presenting a daunting task of selection. Psychosomatic medicine was dominated from about 1930 to the mid 1950's by psychoanalytic concepts. Indeed, the whole field appeared as an offshoot of psychoanalysis, which many people would now regard as a distorted view. During this period the area was most strongly influenced by the writings of Franz Alexander and Flanders Dunbar. Alexander put forward his specificity theory in which he postulated a causal link between a specific constellation of unconscious conflicts, of psychological modes of dealing with them and of their emotional and physiological correlations, on the one hand, and the development of one of several organic diseases, on the other hand. Psychosomatic Medicine: Its Principles and Applications (Alexander, 1952) and Emotions and Bodily Change (Dunbar, 1946) are recommended reading.