There are sometimes difficulties in obtaining appropriate treatment for mentally disturbed offenders. In order to obviate some of these difficulties the Royal College of Psychiatrists and the Department of Health and Social Security have reviewed the present situation and drawn up Guidelines which it is hoped will make it easier for a psychiatrist to find an appropriate place for treatment for such an offender. These Guidelines were approved by Council in January 1977.

This paper describes a psychogeriatric service in Gloucestershire. Agreement on policies was reached with general practitioners, Social Services, other psychiatrists and hospital nursing staff. The day hospital is regarded as the preferred area of treatment for a wide variety of patients, including the severely demented. In this service less than five per cent of admissions appear to become long-stay. With emphasis on day hospital and community support the number of beds for this type of patient recommended by DHSS may be excessive.

A validated objective measure of the state of psychological function was used to determine the incidence and course of psychological dysfunction in a group of evacuees from Darwin following disaster caused by a cyclone (Cyclone Tracy). While psychological dysfunction was increased initially (58 per cent) and at ten weeks (41 per cent), it had returned to an Australian general population control level (22 per cent) at 14 months.

Factors influencing psychological dysfunction were examined, and it is suggested that the sample faced two different stressors at differing times. Initial psychiatric morbidity was most clearly associated with the experience of thinking that one might die or be seriously injured and therefore conceptualized as a ‘mortality stressor’. Psychiatric morbidity at ten weeks appeared to be most closely associated with what has been conceptualized as a ‘relocation stressor’.

Reasons why psychiatric morbidity decreased to a general population control level are discussed.

Seventeen patients were treated by group desensitization and auto-hypnotic training over a period of six weeks for flight phobia, with a highly significant, reduction of fear for the group. Expectation of benefit correlated positively with fear reduction.

A study, covering the years 1964–67, of an integrated psychiatric service for a population of 92,000 was described in this Journal in 1969. This paper describes the continuation of this study to cover the further period 1967–75 and comments on data relating to the whole 11-year period. In this comment, the needs of this psychiatric service have been compared with data from other workers and with current Guidelines from the Department of Health and Social Security.

Ninety-eight matched pairs of patients treated respectively on first admission in a general hospital psychiatric unit or a psychiatric hospital have been followed-up for from five to eight years. The periods of treatment received in either setting remained comparable, and only 3 per cent of patients were in-patients or day patients at five years, while 14 per cent were out-patients and 20 per cent attended their family doctor. There was no evidence in these patients of a transfer of chronicity to the psychiatric hospital, but patients with longer periods of treatment were noted to change hospital from both the general hospital unit to the psychiatric hospital, and in the reverse direction.

Symptom and personality profiles of 33 agoraphobic women and their husbands are examined, revealing some evidence for assortative mating. The implications of this are discussed, and predictions are made about the changes required within a marriage in order to permit the effective symptomatic treatment of the female partner.

Animal experiments have demonstrated the likelihood that all known neuroleptics inhibit transmission in central CA-ergic systems, regardless of their chemical structure and via different mechanisms. For clinical psychiatry this fact prompts a number of questions: (1) is this phenomenon also to be found in human individuals; (2) if so, is it of importance for the clinical (side) effects of neuroleptics; (3) do patients with (schizophrenic) psychoses show signs of central CA-ergic hyperactivity ? This article presents a survey of clinical research focused on these questions which, for the sake of brevity, is confined to DA metabolism. The available data indicate the plausibility of a correlation between inhibition of DA-ergic transmission on the one hand, and on the other hand the therapeutic effects of neuroleptics and the occurrence of hypokinetic-rigid symptoms. The hypothesis that DA-ergic hyperactivity is an important pathogenetic mechanism in schizophrenic psychoses can be based only on indirect arguments; direct studies of the DA metabolism have so far failed to reveal supporting evidence. The possible causes of this failure are discussed.

The previous and subsequent convictions of all those charged with rape in 1961 were studied, together with circumstances of the criminal offence. The proportion of victims whose names were published in newspapers was high (26 per cent), and a high proportion of accused were acquitted (22 per cent). They fell fairly obviously into paedophiliac rapes of girls under 14 (30 per cent), ‘aggressive’ rapists (20 per cent) with a record of other aggressive offences, and ‘others' (50 per cent) with few if any other convictions. Various aspects of the records of these groups are considered. The paedophiles tended to have a wider age range and more often pleaded or were found guilty, and more of them received a medical disposal, rare in others. A small but similar proportion of acquitted and convicted were subsequently convicted of another rape.

In eleven patients with the syndrome of Capgras, the clinical data and the results of electroencephalographic, echoencephalographic, air-encephalographic, psychological and brain-scanning investigations are presented and discussed. All patients were psychotic: six were schizophrenic, four were depressive and one suffered from an organic psychosis. A paranoid element was marked in all cases.

The present evidence supports the view that organic factors are important in the pathogenesis of Capgras' syndrome.

The College notes that this Document results from the work of an Inter-departmental Committee representative of the DHSS, the Home Office, the Lord Chancellor’s Department and the Welsh Office together with observers from Scotland and Northern Ireland, and that it took note of suggestions or amendment to the Act by professional and other bodies including the Royal College of Psychiatrists and MIND; it also considered (where relevant) the work of the ‘Butler Committee’.

The present policy of reducing the number of patients in hospitals for the mentally handicapped involves the discharge of many patients to residential care outside hospital. This paper considers 89 patients discharged from a hospital in the five years 1971–75. 64 (70%) went to facilities controlled by the Social Services Department, ten to other residential homes, eleven to lodgings and four to other institutions. Thirty five (40%) were subnormal (WAIS Full Scale IQ 55–69); the remainder, an unexpectedly high proportion, severely subnormal (WAIS Full Scale IQ, under 55). The majority of the patients discharged were the normal-looking mentally handicapped, few of whom had a specific cause for their condition. The suitability of patients for discharge in relation to the services available was more relevant than their ages or their years in hospital.