The second stage of the College Approval (formerly ‘Accreditation’) Programme involving hospital visits was launched at the beginning of 1974. Each Division of the College appointed a Convenor and a panel of twelve visitors, and these are responsible for visiting the hospitals of another Division in batches arranged by the College office. Each visiting team consists of the Convenor and two panel members, and arrangements for each visit are made by the Convenor, local Clinical Tutor and the College Office.

The purpose of the study was to clarify the attitude of patients with schizophrenia and paranoid psychoses towards hospital personnel and treatment procedures during the two pre-suicidal months. The study was carried out on subjects from south Finland who had committed suicide during a three-year period and had been treated under these diagnoses. The controls included suicides who had received psychiatric treatment for other reasons. A questionnaire was issued to ascertain the opinions of the doctor last in charge of the patient and other personnel. Both groups answered independently, and the opinions given were almost the same. Both groups stated that during the last pre-suicidal months the patients with schizophrenia and paranoid psychoses had shown a more negative or indifferent attitude towards personnel than the controls, and their attitude towards medication had been clearly more negative. Among them there were considerably more patients who had ceased to request support or attention. Thus these patients had developed a degree of despair which manifested itself in a negative attitude towards personnel and treatment.

Psychiatry today mirrors, and in many instances highlights, the dilemmas of medicine. Scientific and technical advances, often not shared by psychiatry, may have diverted attention from these difficulties, but they are there nonetheless. The various roles of the doctor, as clinical scientist, social agent and pastoral counsellor, are intermingled without clear demarcation being attempted or even thought necessary. Priorities appear to be determined by mysterious forces which it would take a Tolstoy to describe, but somehow the chronic sick usually end up last in the line. General practice has only relatively recently come to be recognized as a specialty in its own right, and medical students sometimes still complain of some degree of irrelevancy in what they are taught to what they will have to be doing. It has been said that one of the most important things for them to learn is to have the right attitudes, but apart from agreement that they should have a respect for scientific method there is no clear consensus as to what these attitudes should be.

Most of us pay lip service to the value of this collaboration. Throughout the country, the majority of the patients the psychiatrist sees have been referred by general practitioners, most of whom are in touch with one or more psychiatric clinics. Clearly there is some collaboration; occasional grumbles on either side are dismissed as inevitable because the other is so busy; complaints by the patient, perhaps less occasional, are dismissed because after all they are psychiatric patients. But is all as satisfactory as it might be?

The uses of chlormethiazole (Heminevrin) are briefly mentioned. Differing views of its potential for producing dependence are discussed. The consensus opinion is taken to be that a risk of psychological dependence does exist, but only one case has appeared in the medical literature to date of physiological dependence on chlormethiazole, with withdrawal symptoms. This case is re-examined. A second case is described in which the features of increasing dosage and withdrawal were followed by confusion, disorientation, delusions, hallucinations and muscular spasm and coarse jerking. This is taken as confirmation of the potential of chlormethiazole to produce physiological dependence. Some personal opinions of the author regarding indications for use and incidence of abuse are briefly mentioned.

The proportion of persons with neurotic personalities in flats was not significantly greater than that in houses. Extraversion was not correlated with psychiatric illness or with the tendency to consult a doctor. Flat dwelling, but not house dwelling, was sufficient stress for neurotic personalities to cause, among them, an increase in clinical psychiatric illness. The resulting increase in the overall level of psychiatric illness of all flat dwellers was too small to be significantly greater than that of all house dwellers.

Work has been a highly valued feature of psychiatric rehabilitation programmes. The performance of patients has often been the object of scrutiny and assessment, but the jobs performed by these patients have not been so assessed. This paper describes the development and use of a job rating scale which parallels the use of patient assessment instruments.

Four mentally defective patients who were suffering from short-cycle manic-depressive psychosis were each studied under metabolic ward conditions for about six months. Weekly estimations of erythrocyte Na-K ATPase activity, ouabain sensitive potassium influx, sodium concentration, whole blood cell ATP concentration and blood haematocrit were made. The findings in each patient differed, but the erythrocyte Na-K ATPase activity, sodium and ATP concentration appeared to show cyclic changes related to, though out of phase with, the clinical state.

Frequent references have been made to the similarities between highly creative and psychotic thinking. This study attempts to test the hypothesis that one explanation for such a correspondence lies in the fact that individuals in both these populations habitually employ common attentional strategies which cause them to sample an unusually wide range of available environmental stimuli.

A group of highly creative adults and a group of equally intelligent but low creative adults were compared with a group of acute non-paranoid schizophrenic adults on three tests designed to assess attentional and other cognitive styles.

The results offer support to the view that both highly creative and schizophrenic individuals habitually sample a wider range of available environmental input than do less creative individuals. In the case of the schizophrenic this involuntary widening of attention tends to have a deleterious effect on performance, while, in contrast, the highly creative individual is more able to successfully process the greater input without this incurring a performance deficit.

Thirty-six patients who had had infectious mononucleosis (IM) were followed up a year later and assessed by the Middlesex Hospital Questionnaire and by interview or (in five cases) by postal questionnaire. The results support the view that IM leads to depression in a considerable number of cases, but in this series only women were so affected.

Among twenty patients with narcolepsy intelligence was normal and no characteristic personality or psychopathology was found. A family history of psychiatric disorder was present in five and a past personal history in ten. Eight had a current psychiatric disorder and twelve either a current or past psychiatric disorder. Chronic sexual disorder was present in eleven. Arousal appeared to be the mechanism by which emotions precipitated symptoms. Ten patients were found to have had difficulties at work, in marriage or in social life.