An analysis has been made of patients aged 15 + referred to the community psychiatric service in a Danish rural population during 18 years. The mean referral rate per year was 17·9 per 1,000.

The majority of the patients (79 per cent) were referred to the clinic by the general practitioners, and it is stressed that a close and good co-operation between the psychiatrists and the local physicians is one of the most important factors in establishing a good community psychiatric service.

Only 11 per cent of all referrals were admitted to a psychiatric hospital. The admission frequency for psychoses was only 19 per cent, and it was estimated that it would have been approximately 44 per cent higher, if the service had been of the usual hospital-oriented type. Forty-three per cent of the patients were visited by the psychiatrist in their home at least once and 42 per cent of all 6,000 consultations were home visits.

When evaluating the treatment possibilities it was considered that approximately 50 per cent of all patients referred could be treated by the local physicians after examination by psychiatrists and discussion of the cases with them.

Plasma levels of amitriptyline and nortriptyline were similar in ten depressed patients after administration of amitriptyline hydrochloride in three divided doses or as a single daily dose. Maximum comparability of the plasma levels is achieved by sampling 12 to 16 hours after the single daily dose, or 3 to 7 hours after the morning dose on a thrice-daily schedule. Owing to the long biological half-life of these drugs, therapeutic plasma levels are maintained on a once a day dosage schedule, and the need for sustained release preparations appears questionable.

In 26 depressed patients, a high correlation (0·89) was found between the Hamilton score and a psychiatrist's global rating and between the change (0 · 68) in these ratings during treatment. The Hamilton scale was able to differentiate at the 0·01 level four degrees of severity based on the global rating. Limiting the range of severity measured was found to lower significantly the correlation between the ratings. A prospective examination of a six-item sub-scale of the Hamilton scale developed by Beck and associates failed to confirm its claimed improvement in sensitivity or validity.

A year's cohort of 690 suicide ‘attempters' was followed for two years in order to monitor further attempts leading to referral to the general hospital. Eighteen per cent were involved in one or more repeat episodes, 16 per cent within the first year. More repeats occurred within the first three months than in the rest of the 21 months, and a large majority of repeats occurred within the first year.

Study of a smaller cohort of 141 persons gave information about the frequency and timing of previous attempts. Forty-five per cent had made previous recognized attempts and 10 per cent previous unrecognized attempts. Sixty persons reported 166 previous attempts. Of previous attempters 32 per cent made two or more attempts within a three-month period.

Three types of repeaters are suggested: (a) the chronic, habitual repeater; (b) the individual who repeats several times within a short period, and (c) the ‘one-off’ very occasional repeater.

Imipramine and phenelzine were ineffective in the treatment of five primary unipolar depressives with delusions, even when plasma levels of imipramine and desmethylimipramine or activity of platelet monoamine oxidase suggested that an adequate dose of drug had been given. Four patients went on to receive ECT and all responded well. Five non-delusional patients responded satisfactorily to the antidepressant drug given. Nine out of ten subjects were women. Non-delusional patients showed some placebo response.

ECT is considered to be the treatment of choice in the acute phase of delusional depression in women.

Thirty-three married women, all agoraphobic but most with additional phobias, were exposed to a standard four-day intensive behavioural treatment programme as out-patients. The effects of this on the patients and their spouses throughout a one-year follow-up are reported and discussed.

Social anxiety was found to be the most common complaint in a sample of psychiatric patients reporting social interaction difficulties. High social anxiety was shown to be associated with impairments to social behaviour in socially anxious psychiatric patients and non-psychiatric volunteers. A comparison was made of systematic desensitization and a form of social skills training in the treatment of social interaction difficulties associated with high social anxiety. This indicated that while both therapies were effective in the reduction of social anxiety, the training programme was the more effective in reducing problem behaviour, but desensitization appeared to lead to a wider generalization of improvement as indicated by increases in social participation.

Nine patients diagnosed as having acute schizophrenic psychosis were treated with chlorpromazine. Their clinical response to drug treatment was measured by the use of a clinical rating scale developed from the Present State Examination, and a nurses rating scale. Plasma levels of chlorpromazine (CPZ), 7-hydroxychlorpromazine (7OHCPZ), monodesmethylchlorpromazine (NOR1CPZ) and chlorpromazine sulphoxide (SOCPZ), were monitored during the period of hospital treatment. Correlations were made between the increase in plasma levels of drug or metabolites and improvement in the different PSE scores. These showed that the most significant correlations occurred when symptoms with high diagnostic significance for schizophrenia (Group 1) and symptoms rating perceptual disorders (P) were correlated with plasma 7OHCPZ levels in plasma samples taken before the first morning dose of CPZ. The ratio of 7OHCPZ to CPZ in these samples increased significantly as clinical ratings improved, this correlation being most highly significant against the Group 1 and P scores. The ratio of 7OHPCZ to SOCPZ increased significantly only in the case of Group 1 and P scores. This indicates a preferential shift of CPZ metabolism towards the formation of the active 7OHCPZ during the period of clinical improvement.

The Committee’s terms of reference were ‘To inquire into the deaths by suicide of patients at Warlingham Park Hospital during 1974 and 1975 and to prepare a Report to the Area Health Authority on these and the wider significance in relation to psychiatric care facilities in Croydon.’ The 143-page Report (Committee of Inquiry, Warlingham Park Hospital 1976) is now being read by the local public who demanded the inquiry and by psychiatric hospital managers who expect to find causes and cures for suicides in their own hospitals. Unfortunately, the Report fails to reveal that the suicides were of doubtful significance; that the suggested causes are of even more doubtful validity; and that there was a period of abnormally low rate immediately prior to the period in question, the causes of which the Committee failed to investigate.

A treatment for male genital exposure (exhibitionism) has been given successfully to 15 persons who have previously been resistant to change. The procedure involves the subject undressing before a mixed sex audience, followed by video-taping and subsequent replay to the patient. During the period of nakedness the subject describes in detail the events, his expectations and attitudes, and those attributed to his victim during exposure.

The success of the treatment appears to depend on the profound anxiety induced. During the phase of greatly increased anxiety, cognitive changes previously resisted seem to be made possible.

Schizophrenic patients in treatment with the Hawaii state system have been followed from 1962 to 1972. This cohort includes 1,689 persons: out-patients as well as in-patients; of Japanese, Caucasian, part-Hawaiian, Filipino, Chinese and other ancestries. After ten years, 60 per cent remain registered with the Hawaii Mental Health Division; 14 per cent are found living in the state; 12 per cent are lost to follow-up; and 14 per cent have died. Mortality is analysed for all causes by comparison with similar ethnic and sex sub-groups of the general population.