The recent reorganization of the National Health Service in England and Wales has provided an opportunity for psychiatrists to take part in the planning and development of their local health services. Since extra resources are unlikely to be made available to the mental health services during the next few years this devolution of part of the responsibility for planning means that decisions concerning priorities will more often be made at local level and that psychiatrists will be able to influence them. Each District of a Health Authority area has a Management Team (DMT) with overall responsibility for guiding the Area Health Authority (AHA) in the economic and efficient use of existing resources in the health supporting services in order to meet local needs, and for identifying sections of the services which require expansion, modification or innovation because of unmet need. In order to help them carry out these responsibilities DMTs will appoint ‘Health Care Planning Teams’ (HCPTs) which will consider certain aspects of the services or the needs of any client group thought to require systematic and detailed consideration. The most relevant topics for psychiatrists are mental retardation and adult mental illness, though there will be overlaps with several others, notably geriatrics and child health. Temporary HCPTs may be set up to consider particular issues.

The statement issued on 18 July 1975 by the DHSS reiterates what Dr. David Owen, Minister of State, said in the House of Commons on 25 June 1975 when the question of sterilization of a child under 16 was raised. This was that he had been advised that there were grounds for sterilizing children of 15 or younger. There were some cases where the procedure was undoubtedly necessary, as in the surgical treatment of some carcinomas. A more controversial situation was where a girl was pregnant and pregnancy at any stage of her life would carry grave risks to health. Termination of pregnancy would then be justified and sterilization might be advised at the same time. Then there were severe genetic conditions affecting a girl’s family where there was a high risk of any child the girl might bear suffering from that condition.

A follow-up study was conducted on 146 patients, all the first admissions of one year with the diagnosis of neurosis, admitted as in-patients and day-patients to a hospital giving a general psychiatric early treatment service in Birmingham. Tracing exceeded 97 per cent. Various methods of treatment had been used. Patients were followed up with an interview at their home 12 years after discharge. There were two interviewers, a social worker and a psychiatrist. Assessment at follow-up was on a five-point graded scale in which contributions to the total outcome were made by the social and symptomatic state of the ex-patient.

Twenty-six statistically significant predictive factors were found from the detailed initial information when a graded rating for total outcome at follow-up was compared with presence or absence of the factor. When individual factors were combined, unsatisfactory marital and sexual relationship, poor material management, unsatisfactory social state, and unsatisfactory early environment were predictive of poor outcome. Tests for validity and reliability of the method were carried out.

I write as a psychiatrist who has recently found himself subject to those same symptoms of anxiety and depression which we hear described by the patients in our everyday practice. The realization that one can no longer carry on without help of some sort is alarming, to say the least, but it is the practical problem of where to turn for such help that I should like to put forward for discussion in the hope of establishing guidelines for colleagues who might find themselves in a similar predicament.

Sixty-nine schizophrenic patients (52 men and 17 women) who were consecutive admissions to Shehar Psychiatric Hospital, Taif, Saudi Arabia, were investigated for the phenomenology and frequency of visual hallucinations. Of these patients 43 (62 per cent) were visually hallucinated. It is concluded that visual hallucinations in schizophrenia are of common occurrence in this country. The need for further investigation as to the part played by cultural and other factors is emphasized.

Twenty patients with chronic obsessive-compulsive rituals were treated in a partially controlled design by in-vivo (real life) exposure with self-imposed response prevention. Treatment included 4–12 weeks as in-patients, and lasted a mean of 23 sessions. All patients were followed-up for at least two years. No patients dropped out during the trial, though one refused domiciliary treatment after discharge. Significant improvement in compulsions was found after three weeks of real-life exposure, and continued during follow-up. At two years follow-up 14 patients were much improved, one improved and 5 unchanged; in a third year of follow-up the improved patient became symptom-free after further exposure treatment. Improvement after three weeks exposure predicted good outcome at 6 and 12 months follow-up.

Muscular relaxation treatment had no significant effect on rituals. Modelling of exposure conferred no advantage over exposure alone for the group as a whole, though it may help selected patients. The role of response prevention is unknown. Patients' commitment to treatment facilitates exposure. Domiciliary treatment with involvement of family members in therapy seems crucial in some cases. Pilot group treatment of patients and families together suggests that this may be a useful adjuvant to individual treatment by increasing motivation and aiding follow-up.

Compulsive slowness presents special treatment problems but can be improved by a prompting and pacing approach.

The course of rituals was often independent of that of agoraphobia, marital problems and depression where these had initially coexisted with rituals. Depressive episodes were common before, during and after treatment, and required tricyclic medication.

The trial sample was predominantly female but was otherwise typical of patients with compulsive rituals. Of the 125 obsessive-compulsives seen in the first author's unit over four years 96 per cent were offered behavioural or antidepressant treatment. One quarter refused behavioural treatment after it was offered.

Real-life exposure with self-imposed response prevention is usually an effective procedure for lasting reduction of chronic compulsive rituals in well motivated patients.

This paper describes an attempt to validate a behaviour rating scale used to predict the likelihood of discharge among elderly and long-stay patients in a psychiatric hospital. The scale measured behaviour on the ward as rated by nursing staff. The scale was a sensitive predictor of discharge among those with a low score (indicating least disability), except for patients with organic psychoses. However, many patients with low scores were not discharged. In order to improve the scale's use as a screening technique additional information was considered. The significance of the findings is discussed.

During the course of research into the reorientating of homosexuals routine EEGs were taken to identify patients with low convulsive threshold to exclude them from treatment (aversion). In an initial series of 28 homosexuals 4 showed EEG abnormalities related to organic conditions, but EEGs of the otherwise apparently normal treatment seeking homosexuals showed more marked overbreathing response than would have been expected by chance.

This investigation has provided evidence against the hypothesis that heterozygous carriers of a schizophrenic gene have a reproductive advantage through enhanced fertility. An advantage arising from lower mortality between birth and the end of the reproductive period was not investigated, but should be examined before we search for other explanations of the apparently stable polymorphism of schizophrenia.

The recent reorganization of the National Health Service in Scotland has provided an opportunity for psychiatrists to take part in the planning and development of health services at both area and national levels.

Two similar groups of adult psychiatric patients carrying the diagnosis of anxiety neurosis were compared in their response to different methods of training in deep muscle relaxation. One group received EMG feedback and the other a modification of the Jacobson Progressive Relaxation method. The frontalis muscle was chosen as the target for feedback training and for the measurement of tension reduction in both groups, for the reason that this muscle has been shown to reflect the general muscle tension level in anxious patients. Training was carried out under controlled laboratory conditions, and objective muscle tension levels were obtained. Overall changes in the status of the anxiety symptoms, as determined by global ratings from patients and from primary therapists, were also compared in the two groups at the end of training. The results of the study indicated that both EMG feedback and the progressive muscle relaxation training produced significant reductions in frontalis tension levels. However, EMG feedback was found to be generally superior in producing larger reductions in muscle activity, with a concomitant relief in anxiety symptoms, for a greater number of the patients.

The claim of Hansen (1969) and Hansen and Dimitrakoudi (1974) that whole blood adenosine triphosphate (ATP) levels correlate with depressed affect was examined. The findings from 84 patients failed to confirm any relationship between mood and whole blood ATP. One patient showing the highest correlation (r = 0·85; p < 0.001) between the ATP levels and mood in the original report was re-examined; no relationship was now found (r = −0·25; p > 0·1).

The ages of 87 patients attending an open out-patient group in a general hospital psychiatric out-patient department are analysed in relation to persistence with treatment. A highly significant correlation (p <.001) is obtained between increasing age and continued attendance, and a significantly greater number are found to attend for six months or more in the age-range 37–47 than at other ages. In a sub-group of 35 patients, all of whom had attended more than four sessions and had returned a questionnaire, significant correlations are obtained between age and symptomatic improvement (p < .05) and between continued attendance and improvement in interpersonal relationships (P < .05).