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SYNOPSISAs part of a survey of the need for rehabilitation services in Camberwell, a representative group of 56 unemployed psychiatric patients were selected from the Camberwell Register during 1968; most of these were chronic schizophrenics, and 29, or just over half of them, were living with their parents or siblings. This paper describes a special analysis made by a medical sociologist into the problems of these 29 patients as perceived by their relatives. Assessment of the patient's handicaps and the burden felt by the family showed a dependence on parents of pensionable age which is an obstacle to rehabilitation. Patients were content, but relatives were dissatisfied and experienced considerable financial burden and symptoms of reactive anxiety and depression. The need for special services is emphasized to help the patient towards a more independent existence when the relative dies.

The possible role of environmental stress in precipitating the onset or relapse of acute schizophrenia was investigated by Brown and Birley (1968), Birley and Brown (1970). They enquired about events which could be dated to a definite point in time and which usually involved either actual or threatened danger or important fulfilments or disappointments. They distinguished between independent events, which were outside the control of the subject, and possibly independent events, which were not so clearly out of his control but which seemed unlikely to be produced by unusual behaviour of the subject himself. In their main group of patients a significant concentration of independent events (about 60 per cent) was found in the three weeks preceding onset or relapse of schizophrenia. In examining two small sub-groups they found that 4 of 13 patients (31 per cent) who relapsed after reducing or discontinuing phenothiazine therapy had experienced a life event in the three weeks before relapse, compared with 3 of 5 patients (60 per cent) who had been taking phenothiazines regularly at the time of relapse. Although these proportions are very different, the numbers in the groups are too small for the difference to reach significance. Furthermore the groups were not matched in any way, and there may be important differences between patients who discontinue medication themselves and those who carry on taking it regularly.

SynopsisThis paper reports the social results of a double-blind placebo controlled trial of fluphenazine decanoate. Among patients on placebo there was a deterioration in family relationships, which was due to an increase in aggression, noisiness, talking about delusions, and socially embarrassing behaviour after withdrawal of active drug.

Schizophrenia and affective disorders are the main forms of severe mental illness among women of childbearing age; earlier this century European and American studies showed that the fertility of these patients was reduced. Since the second world war the development of community-orientated psychiatry appears to have resulted in a lessening of differentials between patients and normal women. The present study was designed to estimate probability of marriage and fertility of such patients in London followingthese developments in psychiatry. Over 1,000women aged 16-50 were selected from 1955-63 admissions to a London hospital, and data were collected from medical records. Owing to the demographic heterogeneity of the sample, the analysis of maximum discriminative power was to compare each patient with a normal woman of corresponding age, observed during identical calendar periods, as derived from Registrar General's estimates. The fertility of each patient was compared with that of a normal woman, controlled for age at and duration of marriage, and an assessment was made of the effect of hospital stay on fertility. Before admission, probability of marriage of schizophrenics was just under three-quarters of that of normal women, and after admission this was greatly reduced to just over one-third of normal; women with affective disorders were very similar to normal women as regards probability of marriage, and also fertility. The fertility of schizophrenics was reduced both before and after admission, and much of the latter reduction depended on the effect of hospital stay; however, this fertility differential was too small to be clinically or socially important. The relevance of these results to the population genetics of schizophrenia is noted. Affective disorders are primarily disorders of mood, usually involving a depression, but in a smaller group of patients periods of excitement or elation involving marked overactivity of thought and behaviour. The patient may return to normal between these periods of illness, and although delusions and hallucinations sometimes occur they are usually less prominent than in schizophrenia. Affective disorders generally become evident later in life than schizophrenia, and they often require shorter periods of in-patient treatment, and the medical prognosis is often more hopeful. The expectation of affective psychoses (the most severe forms of the disorder) for a member of the general population varies between 0·3 and 1% from country to country. Milder conditions have also been included in this study, and the expectation of all these affective disorders is likely to be much higher.

Summary and conclusionsDuring January 1970 to December 1974, 134 deaths in people aged 10-50 years investigated by coroners in Greater London were recorded as being due to drug addiction. Over three-quarters of the addicts were under 30, and 105 (78%) were male; 55 (41%) were unknown to the Home Office. Barbiturate overdose accounted for over half of the deaths, though two-thirds of these were in people registered as addicts to notifiable drugs.Since the Home Office index is concerned with addiction to one class of drugs only, it fails to reflect accurately the prevalence of all serious forms of addiction. Owing to the continuous change in drug-taking behaviour, however, probably no one method of assessment can provide a complete picture, and thus complementary research methods are essential.

A647direct medical costs (INR testing, consultations, drug costs). The same patients were invited to complete a patient questionnaire providing data on direct non-medical costs (travel/other expenses for attendance at VKA associated appointments) and indirect costs (opportunity cost and reduced work productivity). Physician and patient reported data were used to calculate costs per patient per year (US dollars). Results: Russian cardiologists (n= 50) provided data on 400 patients (mean age 63, 47% female) and 351 patients (88%) completed the patient questionnaire. Patients had a mean of 9 INR tests in the first year and estimated direct medical costs totaled $151.1. Only 18.5% of direct medical costs ($28.0) were attributable to drug costs. Estimated annual direct non-medical costs were $22.9 per patient due to transport fees, meals and other expenses associated with appointment attendance. Annual indirect costs were $275.6 per patient. Loss of work/ leisure time contributed to this and 10 patients reported being unemployed due to VKA treatment. ConClusions: Although VKA drugs costs are relatively low, this treatment involves regular INR testing and cardiologist consultations which drive the economic burden for Russian NVAF patients treated with VKA.

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