The psychiatric aspects of ageing are a major problem in any country which, like our own, has a low net reproduction rate and a high standard of social responsibility: the proportion of old people in the community steadily increases, so that they provide an increasingly high proportion of our mentally infirm population who must be cared for. But it is not only senile dementia and the other senile and presenile psychoses described in textbooks that make up the problem: less conspicuous failings which may accompany old age also call for attention if the social and preventive sides of our work are to be given due weight. Therefore it is psychiatric aspects of ageing rather than senile psychoses alone that are intended by the title of this paper.

The records of 79 children whose firesetting led to referral to a Children's Hearing (the Scottish equivalent of a juvenile court) were examined. All but one of the children were boys. They had very disturbed backgrounds, with much family disruption and absent or unemployed fathers. Firesetting was predominantly a group activity and the damage caused was extensive. Although the children frequently engaged in other offences, in over 90 per cent there was no recurrence of reported firesetting within the limited period of possible follow-up.

The reports on the emotional reactions and adjustment of patients to chronic haemodialysis are often contradictory; nevertheless, all agree that this treatment is stressful.

In 1962, Perley and Guze introduced specific criteria for the diagnosis of hysteria based on clinical observations made in 1951 by Purtell, Robins and Cohen. A number of reports have been published since 1962 evaluating the limits and usefulness of these criteria. A recent paper by Guze (1967) summarizes a large part of this work and explores various problems of definition and methodology. In 1968, two papers appeared in this journal evaluating the criteria for hysteria by applying them to women with chronic medical illnesses (Woodruff) and to normal women (Farley, Woodruff and Guze). The present study is an extension of the method used in those reports.

It is becoming increasingly important, in the administration of psychiatric units, to single out the likely absconder from the rest of the hospital community. The following study has been embarked upon partly to outline a sketch of a hypothetical absconder, and partly to lay down a method of study which could be applied to other institutions with similar problems. The problem of absconding is of comparatively recent origin, as the “open door policy” has become generally adopted in British mental hospitals.

The extraversion–introversion dimension of personality is believed to have an inverse relationship with cortical arousal. Brain capillary perfusion is a well established index of brain function and arousal. Regional cerebral blood flow was measured in 51 right-handed females whose personality structure was examined with the Eysenck Personality Inventory (EPI). Significant inverse correlations were found between the brain blood flow and the extraversion–introversion score of EPI.

A sample of patients with puerperal mental illness requiring hospital admission were diagnosed retrospectively according to the criteria of DSM III. Comparisons were made with controls matched for diagnosis on a number of features of past history, symptoms, management and outcome. Puerperal illness was associated with more frequent puerperal and less frequent non-puerperal previous admissions, more frequent delusions and greater use of ECT.

Forty-two long-stay hospital patients with chronic schizophrenia were divided into age and sex-matched groups with and without temporal disorientation, and assessed for premorbid academic performance and past physical treatment. The schooling of schizophrenic patients who had cognitive impairment, as identified by gross temporal disorientation, did not differ from those who were cognitively intact. The groups did not differ in past history of ECT, insulin coma, neuroleptic treatment, or psychosurgery. Patients with age disorientation were on lower mean doses of neuroleptic or anticholinergic medication. Gross cognitive impairment thus appears to occur in the course of the disease and is not due to physical treatment.

The case histories are examined of 41 patients who were admitted to hospital for the first time with a diagnosis of obsessive-compulsive neurosis. Aspects of the phenomenology are reported which presented between the first appearance of obsessive-compulsive symptoms and discharge from the first admission.

The mean age for admission was 31·6 years (SD 14·3) and 68 per cent of the sample were women. The women showed significantly higher incidences of contamination phobia and of compulsive cleaning behaviour than did the men. Cleaning behaviour and avoidance of feared stimuli were the most frequently encountered manifestations of compulsive behaviour.

Clinical observation as well as experimental results have indicated abnormalities in the responses to sensory stimulation in autistic children. Observers have noted occasional over-responsiveness in the absence of any obvious sensory defect, though more frequently under-responsiveness to visual or painful and particularly to sound stimulation is reported. Thus, Goldfarb (1961) observed the frequent absence of startle responses to sound in autistic children, and Anthony (1958a) and Rutter (1967) also noted a lack of reaction to auditory stimuli. Hermelin and O'Connor (1964) and O'Connor and Hermelin (1965) found marked under-responsiveness to sound, if compared with the response to light and touch, though they also reported impairment of visual discrimination.

The routine air ventriculograms of 66 psychiatric patients, aged from 22 to 73 years, taken during the psychosurgical operation of stereotactic subcaudate tractotomy, were studied. Ventricular size was unrelated to progressive ageing, but a minority of patients over 60 years had abnormally large ventricles, not invariably associated with cognitive impairment on testing. Enlargement was associated with a clinical diagnosis of schizoaffective illness but not with past ECT.

To examine the neuropsychiatric effects of infection with HIV, 220 drug users (27 HIV negative, 193 HIV positive) completed tests evaluating premorbid intelligence, memory, non-verbal performance, information processing speed, and mood. When these measures were compared cross-sectionally by the severity of HIV illness, symptomatic patients (in CDC stage IV) were impaired on Trails B, two-choice decision time, delayed recall of the Wechsler Logical Memory Test and most components of the Auditory Verbal Learning Test. These findings imply reduced capacity for concentration, speed of thought and memory. When 101 patients were retested a mean of 16 months after their initial assessment, performance on Trails A and B, Block Design and delayed recall of the Wechsler Logical Memory Test deteriorated more for patients at, or progressing within, CDC stage IV, than performance of patients at stage III. The results broadly correspond to the cross-sectional findings. However, there was a decline in all tests of memory function for the sample independent of clinical staging. This may be evidence of brain involvement before the appearance of other symptoms. Self-rated measures of mood did not change cross-sectionally, progressively, or interactively with time and stage of HIV illness, and cannot account for the changes in cognitive function observed. Change in drug use, similarly, does not account for the cognitive findings. Four (5%) of the retested subjects developed AIDS dementia complex, but most of the performance and memory impairments seen were subclinical despite the destructive neuropathology presumed to underlie intellectual decline in patients with HIV infection. An exploratory analysis of treatment with zidovudine in 65 patients with stage IV disease showed no demonstrable benefit for cognitive function.

Kreitman (1979) reported that up to one-half of patients given out-patient appointments one week after an episode of deliberate self-harm (DSH) fail to attend, and gave a number of possible explanations for this. Firstly, parasuicide is often the result of a crisis which may have resolved (albeit temporarily) by the end of a further week. Secondly, someone in a state of heightened tension may find one week too long to wait, and may resort to other strategies to deal with his problems. Thirdly, many parasuicides may find a psychiatric label unacceptable in the context of their problems, and fourthly, an appoint ment made for a fixed day and a fixed hour may not fit the need for immediate action which the subjects subculture had inculcated in him as a habit pattern. Morgan et al (1976) reported that up to 40% of their DSH patients either did not attend any appointment or failed to complete their treatment. Two possible explanations for this were that they either felt that they did not need psychiatric treatment, or else believed that psychiatric treatment was not an answer to their problems. Kessel and Lee (1962), probably in line with much psychiatric practice, did not give a follow-up appointment to 40% of their self-poisoners; this was for two reasons. Firstly, these patients did not have a problem for which psychiatric treatment was appropriate and secondly, many of these patients had an entrenched personality disorder, which made it unlikely that psychiatric intervention would be beneficial.