This is a report by a Working Party of general and specialist psychiatrists appointed in June 1972, by the Executive Committee of the Scottish Division of the Royal College of Psychiatrists. The remit of this Working Party was ‘to consider and make recommendations on the future provision of psychiatric services in Scotland’.

This paper presents an analysis of the factors which influence coroners in their decision to classify some deaths as suicides and others as accidental or ‘open‘. The most important influence on coroners' behaviour was seen to be the manner by which the person died. Those who died by cutting, hanging, drugs or gas were significantly more likely to receive a suicide verdict than those whose deaths were due to drowning, jumping, shooting or poisoning. If the deceased left any intimation of a suicidal intent, this increased the likelihood that a suicide verdict would be returned. Finally, persons aged under 40 were significantly more likely to be returned as suicides than older victims, especially those aged over 70. All of these results show that coroners operate by observing the law as it defines suicide, that is, by looking for evidence of intent of self-inflicted death. Our findings concerning the factors associated with the suicide verdict help to clarify the meaning of the official data on suicides in Ireland, and illuminate the reasons why, using clinical rather than legal criteria, a much higher rate is obtained.

25-year-old female patient with a psychotic illness lasting three months in which schizophrenia and depressive episodes occurred was studied by serial EEGs. These were coded, masked and rated in a set way without knowledge of the clinical state. It was found that the schizophrenic state was characterized by a decrease in the amount and poor organization of alpha activity, as well as the occurrence of paroxysmal phenomena in particular atypical spike and wave. In the depressive episode, alpha activity was prominent and only scanty paroxysmal features were seen. Using these criteria a series of EEGs from psychiatric patients were assessed ‘blind’ with a view to separating them into either a schizophrenic or a depressive category. This proved possible in 17 cases (9 depressive and 8 schizophrenic). In only two was the categorization completely misjudged. These results suggest that further detailed study of the EEG, possibly with computer analysis, combined with assessment of the behavioural state might not only yield useful diagnostic information but also lead to a better understanding of the underlying neurophysiological basis of certain mental disorders.

The brain stems of 24 mental hospital patients and 10 control patients were examined. Ten mental hospital patients were either deluded or auditorily hallucinated in clear consciousness, and of this group 8 presented with a diagnosis of schizophrenic syndrome. The nature and significance of lesions found in the midline reticular nuclei and the trigeminal n. are discussed. The results, and the dearth of other published material on this subject, indicate the need for further work in this field.

Large differences have been found between the Isle of Wight (IOW) and a (former) inner London borough (ILB) with respect to the rates of emotional (neurotic) disorders, conduct disorders and specific reading retardation in ten-year-old boys and girls (Rutter et al., 1975; Berger et al., 1975). This paper presents preliminary considerations on possible reasons for these differences. Any explanation must account for the fact that the differences in the rates apply to three rather disparate disorders. The epidemiological characteristics and psychosocial correlates of emotional disorders in childhood differ quite markedly from those of conduct disorders, and it appears highly likely that the causes of the two disorders are different (Rutter, 1965, 1970a; Rutter, Tizard and Whitmore, 1970). Although specific reading retardation overlaps markedly with conduct disorders, to a considerable extent it seems to have a separate set of aetiological influences (Rutter and Yule, 1973). Furthermore, there is little association between specific reading retardation and emotional disorder in childhood. It is also notable that the higher rates of disorder in London compared with the Isle of Wight apply just as much to girls as to boys, in spite of the marked differences between the two sexes in the correlates of psychiatric disorder (Rutter, 1970b).

There is now extensive evidence that autistic children manifest a specific cognitive defect involving language impairment (Rutter, 1974). The presence of such a deficit is demonstrated by the pattern of clinical findings (Rutter, 1968; Rutter, Bartak and Newman, 1971), the long term course of the disorder (Rutter, 1970), and the results of systematic experimental studies (Hermelin and O'Connor, 1970). Nevertheless, basic questions remain concerning the meaning of this deficit for theories on the nature and causation of infantile autism. First, what are the boundaries of the cognitive deficit and in particular does it extend outside language? Second, does it constitute the primary handicap which gives rise to other symptoms? Thirdly, if it does, does the cognitive deficit lead directly to the behavioural syndrome or must there be an interaction with a particular set of environmental or other circumstances for the syndrome to develop?

For about fifteen years now a tradition has been evolving in the psychiatric literature towards a taxonomic separation of suicides and attempted suicides, on the assumption that they involve distinct psychogenic factors (Stengel and Cook, 1958; Farberow and Schneidman, 1961). However, even the originator of the distinction agreed that a better understanding of attempted suicide could be gained if it is regarded as conveying a degree of uncertainty that the attempt will succeed or fail (Stengel, 1958), and that the separation of ‘… suicide and attempted suicide … is artificial (as) … it is possible to view suicidal acts as a whole and irrespective of outcome’ (Stengel, 1969, p. 121). The latter view has been reflected in the recent introduction and usage of the term ‘suicidal behaviour’ which includes both suicides and attempted suicides (Hetzel, 1971).

This study examines a series of elderly admissions to a psychiatric hospital and a geriatric hospital serving the same catchment area in order to evaluate the success of the two hospital services in separating their patients into two groups, and to study the effect, if any, on the prognosis of those patients who were ‘incorrectly labelled’.

The National Health Hospital Service depends heavily on overseas medical graduates for staffing the junior grades. In adult psychiatry alone, at the last count on 30 September 1973, 570 out of 911 Registrars and Senior House Officers (62.6 per cent) were medical graduates who were born outside the United Kingdom or the Republic of Ireland (D.H.S.S. Hospital Medical Staff statistics, 1974). The majority of these are likely to be foreign graduates whose mother tongue is not English. Since psychiatry is the most language-bound branch of medicine, those training in psychiatry are likely to have special difficulties. This applies to learning the subject, to passing the examinations and to the actual practice of psychiatry.

The increasing involvement of psychiatrists in the general hospital presents opportunities for teaching medical students about the psychological evaluation and management of patients. We have found it useful to introduce this topic during the first year, by collaborating with colleagues from medicine and surgery in an interdepartmental course on patient care.

1. The incidence of non-fatal deliberate self-harm throughout the City of Bristol during 1972 and 1973 was assessed by means of a survey of patients presenting to Accident and Emergency Departments of hospitals in the area. Fatal or repeated acts of self-harm were not included in the survey. 2. The rates for females exceeded those for males at all ages, with peak incidence of 645 per 100,000 females (age group 15–29 years) and 334 per 100,000 males (age group 25–29 years). Ninety-three per cent had taken a drug overdose of some kind. 3. The problem was found in all electoral wards of the city, though its distribution was markedly centripetal, with a central area having morbidity rates up to 2.8 times that for the city as a whole. 4. The socio-economic correlates of deliberate self-harm were examined by reference both to a series of 368 patients interviewed soon after the event and to the pattern of its distribution throughout the city. A significant positive association was found with areas of overcrowding, lack of exclusive domestic amenities and high proportion of foreign born residents, but there was no correlation with the proportion of persons living alone nor with the type of accommodation. 5. The central high rate area was found to be heterogeneous in socio-economic terms, ranging from a student and young professionals' bed-sitter area to one with a high proportion of unskilled manual labourers and New Commonwealth immigrants. 6. The aetiological implications of the ecological findings for deliberate self-harm throughout the city are discussed.