The medical schools of origin of 531 psychiatrists who had qualified in the U.K. in the period 1961–1970 were ascertained. Psychiatrists were for the purpose of the study operationally defined as those who had taken the Royal College of Psychiatrists' Membership examinations since its inception. There were large discrepancies, as much as five-fold, between different medical schools, and no ready explanation is forthcoming. There were also discrepancies in the proportion of women graduates opting for psychiatry.

Between 1953 and 1974 the author made psychiatric examinations for the prosecution of 400 persons, 367 males and 33 females, accused of the murders of 307 victims, 194 males and 113 females. The 367 males were accused of 273 murders, 172 male and 101 female victims, and the 33 females were accused of 34 murders, 22 male and 12 female victims. The salient features amongst the accused were maleness, youthfulness, the causal importance of alcohol, the rarity of suicide after murder and the high percentage of psychiatrically normal persons: in these last two respects the picture differed from that reported in England and Wales. The normality of these Scottish accused was further shown by the finding that in the decade 1965 to 1974 no material psychiatric abnormality was seen in 90 per cent of the males examined.

Many psychiatrists assert that an expansion of mental health services in the developing countries is overdue. This will only take place if: (i) the tasks of mental health care are undertaken by a wide range of non-specialist health workers, including those responsible for primary health care; and (ii) services are directed initially at a very limited range of priority conditions. The method of priority selection is discussed, and the process required for translation of priority decisions into health action is exemplified by two illustrations.

These documents were prepared by Dr J. A. Baldwin, Dr J. Leff and Professor J. K. Wing at the request of the Executive Committee of the Social and Community Psychiatry Group of the College. After extensive consultation they were approved by the Executive and Finance Committee as representing the policy of the Royal College of Psychiatrists.

Copies of the Code of Practice (Annex B), and of the unpublished Annex C, Technical Arrangements for Ensuring Confidentiality and Annex D, General Features of Medical Information Systems, are obtainable from Professor J. K. Wing, M.R.C. Social Psychiatry Unit, Institute of Psychiatry, De Crespigny Park, London SE5 8AF.

Fifty-five patients with presenile dementia were examined. There were 28 women and 27 men, and the mean age was 59 and 56 years respectively at the time of the study. A large series of psychometric tests was used, and with the aid of age-matched non-demented controls five significantly different cognitive reduction groups could be identified. In the demented patients the regional cerebral blood flow (rCBF) was determined with an eight-detector or 32-detector equipment. There was a rough proportionality between the cognitive reduction and a decrease of the cerebral blood flow (especially the flow in the grey matter). In addition, certain regional flow abnormalities correlated with specific cognitive functions in a manner resembling the cognitive defects found in focal brain lesions in the same region. Thus, patients who showed only memory disturbances demonstrated a focal flow reduction in the temporal region. More severely affected patients, with reduction of verbal abilities and signs of agnosia, showed very low flows in occipitotemporo-parietal parts of the hemisphere. The results offer a principal confirmation of the dynamic field theory concerning the functional organization of the cerebral cortex (Luria, 1966).

A representative sample (R.S.) of 79 subjects living in Edinburgh common lodging houses was compared with a clinical series (O.S.) of 44 patients from the same type of residence. C.S. patients were more likely to be out of work, to be under 55 years of age, and to have been married at some time. They had spent much shorter times in lodging houses, in Edinburgh and at their current address. Alcoholism was rather more often diagnosed in the C.S., and personality disorder much more often. Schizophrenia tended to be found more in the R.S. The O.S. obtained higher Personal Illness and ‘Character Disorder’ scores. It is concluded that those subjects presenting to the psychiatric services are a highly selected group quite unrepresentative of homeless single persons in general.

One-hundred husbands, diagnosed as suffering from alcoholism, and their wives, were followed up twelve months after initial consultation and assessment. Follow-up information was complete in 89 cases. On the basis of both husband and wife accounts of the husband's drinking behaviour during the follow-up period, and their assessment of the drinking problem at twelve-months follow-up, 28 were classified as having a ‘good’ outcome and 29 as having a ‘bad’ outcome. In the remaining 32 cases outcome was considered ‘equivocal‘.

A composite measure of marital cohesion was predictive of twelve-month outcome classification, cohesive marriages being significantly more likely to have a good outcome. The measure of marital cohesion was based upon husband and wife reports of mutual affection and of husband involvement in family tasks, favourable spouse perceptions and meta-perceptions, and optimism about the future of the marriage. Composite measures of dominance balance within the marriage were not predictive of outcome.

Husband's job status, husband's self-esteem, and wife's reported hardship were not independent of marital cohesion, and were themselves predictive of twelve-months outcome. When these variables were partially controlled it was found that marital cohesion remained predictive for husbands with relatively low status jobs and husbands with relatively low levels of self-esteem. It is an over-simplification to state that either the marriage, the spouse, or the severity of the patient's condition is alone the cause of variation in outcome.

It is possible to integrate these findings with those of other studies on the influence of family variables on the outcome of conditions other than alcoholism. Together these studies suggest a general hypothesis linking a breakdown in the cohesiveness, or mutual rewardingness, of family relationships and unfavourable outcomes following treatment or consultation for psychological disorder.

The welcome visit of the Royal College of Psychiatrists brings to mind the close links which exist between the University of Padua and Britain.

The subjects of this study were eighty misusers of heroin who lived in the New Town of Crawley, West Sussex. The relationship between their criminal histories and their histories of drug misuse were examined. It was found that more of the heroin misusers than would be expected had been convicted of criminal offences before they began to misuse drugs, while the reduction or cessation of heroin use during a four-year follow-up period was accompanied by a reduction in convictions. Some social characteristics of the male heroin misusers were compared with those of two other Crawley groups—a group of juvenile offenders who did not misuse heroin and their control group of non-delinquents. Characteristics commonly associated with maladjustment did not distinguish the heroin misusers from the juvenile offenders, nor were they found to be associated with the continued use of heroin. Analysis of the data in epidemiological terms suggested that among the necessary conditions for an outbreak of drug misuse in a particular community the availability of drugs together with socializing drug users were more important than the presence of predisposed individuals.