In 1972 three old hospitals were closed and patients transferred to a new hospital for the mentally handicapped. Four to six weeks before transfer, disturbed and a sample of non-disturbed patients were rated on a selected scale; they were again rated four to six weeks after transfer. The disturbed patients numbered 39 per cent of the total and both men and women shared a significant improvement, though the men did not improve to the same extent as the women. There was also a significant improvement among the non-disturbed patients, though this did not apply to the epileptic patients.

The application of techniques of behaviour modification to chronic adult psychiatric in-patients has for the most part been directed towards individual patients, and to specific problems such as hoarding, eating, soiling or speech (Ayllon, 1963; Ayllon and Haughton, 1962, 1964; Ayllon and Michael, 1959; Bachrach et al., 1965; Isaacs et al., 1960; Mertens and Fuller, 1963; Kennedy, 1964; Sherman, 1965). In this country, Baker (1970, 1971) and Kassorla (1968) have reported on the use of operant conditioning in reinstating speech in mute schizophrenics. There have, however, been few British reports relating to groups of patients, for example in wards where nurses have been trained to function as ‘behavioural engineers' (Ayllon and Michael, 1959); whereas Krasner and Attowe (1968) specified no fewer than 200 institutions and individuals in the U.S.A. currently involved in token reinforcement programmes, concerned with disturbed or autistic children, delinquent adolescents and the mentally handicapped; 22 projects involved chronic adult psychiatric in-patients.

IQ, appears to play a major role in the development and course of schizophrenia. Patients with low IQ tend to have an earlier onset (Pollack, 1960; Belmont, Birch, Klein and Pollack, 1964; Offord and Cross, 1971), to stay in hospital longer (Offord and Cross, 1971) and improve less while there (Pollack, 1960), to remit less often (Stotsky, 1952) and to make a poorer post-hospital adjustment (Pollack, Levenstein and Klein, 1968) than patients with normal or high IQ. In addition, schizophrenics, particularly the men, tend to have lower childhood IQs than their siblings (Lane and Albee, 1965; Offord, 1974).

Remember that the interview with the examiners is short. It is therefore very important that you do not waste time talking about irrelevancies and giving a long list of normal findings.

If a diagnosis etc. is possible, give it in the form of a Case Formulation. If it has not been possible to make a diagnosis, say so. You can then offer either to discuss the case or to propose what collateral information you think is required, e.g. an interview with a relative, a P.S.W.’s report, psychological or other kinds of tests, and so on.

Manic-depressive psychosis is considered to comprise two different clinical entities, bipolar and monopolar. This dichotomy is based mainly on Western clinical material. The present study aimed at eliciting any differences that might exist between monopolar and bipolar manic patients in respect of three factors: (i) occurrence of psychiatric illness in first degree relatives; (ii) parental death before the patient's 15th birthday; and (iii) socio-economic status of the patient. Venkoba Rao (1973) studied the differences between monopolar and bipolar endogenous depressives on three factors: occurrence of affective disorder (including suicide) in first degree relatives; parental loss before the patient's 12th birthday, and the extent of ‘jointness' of the patient's family.

Psychotherapy can borrow an empirical base from behaviour technology, a discipline which involves the control and prediction of behaviour through environmental manipulation. Fundamental to the achievement of control and prediction is measurement.

An analysis of the drug regimes prescribed to two separate groups of unselected schizophrenic patients indicates certain trends of clinical importance. The results demonstrate a need for the adoption of a personalized dose regime. The scatter of dose regimes found effective is too great to recommend a standardized approach to the prescription of L.A.P. injections.

Two other results of particular significance are that the dose of drug required to control symptoms can be gradually reduced in nearly half of patients, and that helpful trends in prescribing were identified that will help the clinician to abolish side-effects.

In 1965, the Department of Social and Preventive Medicine of King George's Medical College, Lucknow, established an Urban Health Centre in the Alambagh suburb of Lucknow city and registered 500 families representing a cross-section of the resident population with the purpose of training undergraduate and postgraduate medical students in the practice of community health (Gupta, 1966).

Pierce-James (1967), has shown that British heroin addicts have a very much higher mortality rate than the general population. The same applies to American narcotic addicts; a 20-year follow-up study of a group of narcotic dependents showed the very high death rate of 23 per cent over this period (Vaillant, 1973). Pierce-James (1967), distinguished between suicidal, accidental, and other causes of death, and also demonstrated a higher rate of successful suicide attempts among heroin addicts than in the general population. Connell (1965) suggested that the incidence of suicidal threats and attempts in childhood and adolescence is higher than is generally recognized, and in both adolescents (Gould, 1965) and intravenous narcotic addicts (Frederick et al., 1973) suicidal and self-destructive behaviour is more common than successful suicide. The distinction between suicidal attempts and self-destructive behaviour is unclear. Stengel (1964) defined as suicidal attempts, ‘all cases of potentially dangerous self-poisoning or self-inflicted injury.’ The present study, however, does not assume that self-poisoning or self-inflicted injury necessarily implies suicidal intent.

This report describes a patient who developed a peculiar movement disorder and delirium after receiving hypnotics and phenothiazines during pentazocine withdrawal.

A survey of 351 accidents occurring in a two-year period in a psychiatric hospital showed that 77 per cent of the accidents involved female patients and 48 per cent involved patients with organic psychoses; 236 accidents were falls and 280 occurred in the ward setting.

In 277 instances adequate controls were available. Seventy-five per cent of the accident patients had received a psychotropic drug on the day of the accident as opposed to 61 per cent of the controls. The possibility that the side-effects of psychotropic drugs may have contributed to some of these accidents is discussed.

There is accumulating evidence of the clinical effectiveness of selective stereotactic psychosurgery in some severely disabled psychiatric patients who have not responded to other forms of treatment (Ström-Olsen and Carlisle, 1971; Bridges, Göktepe and Maratos, 1973; Kelly et al., 1973). The risks of adverse effects resulting from operation are now small, and their significance is further diminished when related to the distress over long periods of those patients who are suitable for psychosurgery. The criteria for selection have been considered by Bridges and Bartlett (1973).