Ninety patients with severe anorexia nervosa fulfilling DSM-III-R criteria were assessed in depth in terms of their family developmental psychopathology and then randomly allocated to either one of three treatment groups or to no treatment. In three treatment regimes, a behavioural approach to diet and weight gain was coupled with individual and family psychotherapy directed at the adolescent maturational problems. All three treatment regimes were highly significantly effective at one year in terms of weight gain, return of menstruation, and aspects of social and sexual adjustment. Body weights above those at pubertal onset were achieved for the group mean maximum and one-year follow-up weights for all three treatment groups but not the control group.

We have studied the association of muscle strength (quadriceps, biceps, handgrip), measured by a portable chair technique, with functional status (Barthel Index, manual dexterity, Mental Test Score, history of falls, fracture, prescribed drugs), in a sample of 92 elderly subjects attending a Local Authority Day Centre and Day Hospital. Anthropometric measurements and hand-grip strength were also measured in 30 young controls. Muscle area, mass and strength were significantly greater in young controls. Elderly men had significantly greater muscle area, mass and strength than elderly women. Muscle strength correlated with several measures of functional status. Using stepwise multiple regression, an independent association of muscle strength with manual dexterity, Barthel Index and receipt of domiciliary services is demonstrated.

The clinical characteristics of a consecutive series of 36 male anorectics were compared with those of a similar series of 100 female cases. Social class background and mean age of onset were found to be similar as were the majority of clinical features at presentation. Anorexia nervosa was associated with diminished differences between the sexes in terms of physical, experiential and behavioural characteristics directly related to the condition, and in terms of general psychoneurotic characteristics. The condition is one within which the individual is sadly reduced to an existence rooted in the experience, behaviour and impulses of starvation including the impulse to ingest and the consequent defences against this latter propensity and its implication of weight gain. Only the 'choice' of defence relates to premorbid 'personality' characteristics and thereby continues to characterize the individual. Overall the same background and presentation factors in both sexes predict similar outcomes, though a vomiting defence at presentation predicts good outcome for males and poor outcome for females. The condition is very rare in the male and such presentations may help to shed light on its overall nature.

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While research has shown community-based psychiatric care to be as good as, or better than, hospital-based care, generalisation to clinical practice has been difficult. This prospective, randomised controlled study examined a community-based approach feasible within NHS conditions. Ninety-four patients were randomly allocated to experimental and 78 to control treatments and followed for one year. The groups were well matched apart from an excess of psychotic control patients. No differences in clinical or social functioning outcome were found. Both groups improved substantially on clinical measures in the first six weeks, with some slow consolidation thereafter. There were three suicides in the control group and one in the experimental group. Access to care was better in the experimental group (93% attended assessment) than in the control group (75% attended assessment).

Acute renal failure (ARF) occurs in wide range of conditions, making the evaluation of its prognosis a difficult task. Data regarding prognostic factors in ARF in a general population in developing countries are scarce. The objective of the study was to describe predictors of mortality in ARF that are relevant in the developing world. This prospective study was carried out over a one-year period; all hospitalized adults with ARF were included in the study. Predictors of mortality studied included causes of ARF, pre-existing diseases, and severity as well as complications of ARF. Of 33,301 patients admitted during the study period, 294 (0.88%) were either admitted with or developed ARF after hospitalization. Mean age was 43.9 ± 16.9 (18-86 yrs). Sepsis was the most common cause (63.26%). Pre-existing diseases like cardiovascular disease (CVSD), respiratory system disease (RSD), central nervous system disease (CNSD), hypertension, diabetet mellitus (DM), and malignancy were significantly higher in elderly as compared to younger patients. On univariate analysis sepsis, hypoperfusion as a cause of ARF and hospital-acquired ARF were associated with higher mortality. Pre-existing diseases viz. RSD, CVSD, CNSD, and DM had higher mortality. Among the severity and complications of ARF, oliguria, bleeding and infection during the course of ARF and critical illness were predictors of poor outcome. Age >60 yrs was associated with significantly higher mortality. However, on multivariate analysis, only critical illness (odds ratio 37.3), age > 60 years (odds ratio of 5.6), and sepsis as cause of ARF (odds ratio of 2.6) were found to be independent predictors of mortality.

The notions of 'early-onset' and 'prepubertal' anorexia nervosa are reviewed, with particular reference to the role of the pubertal process within the condition. A database of 650 female cases is utilized to identify a small sub-group (n = 30) who developed the condition before the menarche. Many clinical, familial, social and precipitating factors distinguish this group from post-pubertal cases as a whole, and a sub-group of post-menarcheal cases (n = 42) matched for age. An explanation for previous inconsistent findings in 'early-onset' and 'prepubertal' anorexia nervosa is advanced.

Social, demographic and clinical information was collected retrospectively on all 99 people referred to a South London hospital in 1986 under Section 136 of the Mental Health Act (1983), this being the last complete year before local changes in the procedure for assessment of Section 136 cases were initiated. An over-representation of Afro-Caribbeans was confirmed and this seemed to be accounted for largely by young men under the age of 30 who with Africans had very high rates of previous Section 136 referral, were more likely to be perceived as threatening, incoherent and disturbed but less clearly diagnosed with a mental illness, and were more likely than the Caucasian sample to be living in stable accommodation. The implications of these results are discussed.