In a study of the prevalence of depression in 235 elderly patients who attended general practice surgeries less than 12% of the disagreement between the research assessment of depression and the general practitioner's assessment was due to "missed" depression. There were, however, low rates of referral and of treatment with antidepressant drugs. If these findings are confirmed the study of the management and outcome of depression in such patients may be more rewarding than attempts to improve the recognition of depression.

One hundred consecutive referrals to a general medical out-patient clinic were evaluated psychiatrically under blind conditions in order to investigate the nature and occurrence of non-organic disease presenting as gastrointestinal illness. Twenty-eight patients had marked psychiatric illness with or without physical illness, and there was an association between psychiatric illness and the absence of organic disease, as determined by outcome at follow-up of 4-11 months. Patients with obsessional traits were more at risk of non-organic illness. Historical items indicating a likelihood of non-organic gastrointestinal illness included "nerves", "depression", unhappy childhood, early parental loss and early separations from parents during childhood. Psychiatric illness often persisted after treatment for physical symptoms. Some of the techniques used in this study to identify psychiatric illness could be usefully employed in everyday practice.

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Descriptive data on referrals and workload of the first open-access multidisciplinary old age psychiatry service have generated cause for both celebration and concern.