Since the introduction of anti-depressant drugs into general use in the psychiatric field, there have been several statements to the effect that such a drug administered concurrently with electrical treatment reduces the number of shocks required to achieve a satisfactory response. This has been claimed by Sargant (1961) but without experimental support. Dunlop (1960) has published a comparison between the number of electrical treatments given with the anti-depressant drug during a particular attack, and the number of treatments without the aid of a drug in an earlier attack in the same patient: however, comparison of treatments in the same group of patients at different times is unreliable because there may be other factors to account for the differences noted. A controlled trial is necessary to ensure that all factors are constant other than the one under consideration.
Psychiatrists have frequently pointed out that in a high proportion of individuals who commit suicide it is apparent that there is pre-existing psychiatric illness. It has been further shown that many of these people have received medical care and have been attending their doctor within four weeks of their death (Motto and Greene, 1958; Seager and Flood, 1965). The implication of these findings is that doctors do not always recognize psychiatric illness in their patients and are certainly not attuned to the possibility of suicide, even when the patient frankly states that he finds life is not worth living and that he has considered ending his life. Such straightforward information is not accepted at its face value. The doctor may hold the mistaken view that people who talk about suicide do not in fact commit the act. This statement is manifestly incorrect. It has been shown (Robins et al., 1959) that 70 per cent. of suicides have declared their intention of committing the act days or weeks beforehand.
“That the deceased took his life while the balance of his mind was temporarily disturbed” has been the Coroner's traditional verdict in cases of suicide; a verdict adopted to circumvent retribution by society and particularly to allow of burial in consecrated ground and avoid forfeiture of property to the Crown (Williams, 1958). There is a distinction between such a finding with its legal import and that of the psychiatric assessment, and this must necessarily affect psychiatric studies undertaken in the endeavour to understand the state of mind of the person who encompasses his own death, or to examine the wider implications of suicide in relation to the epidemiology of mental illness. Public opinion and cultural pressures have their effects on coroners' verdicts; and guilt or shame on the part of relatives or medical attendants may result in distortion or concealment of information.
"OBJECTIVE--To compare the efficacy of home based care with standard hospital care in treating serious mental illness. DESIGN--Randomised controlled trial. SETTING--South Southwark, London. PATIENTS--189 patients aged 18-64 living in catchment area. 92 were randomised to home based care (daily living programme) and 97 to standard hospital care. At three months' follow up 68 home care and 60 hospital patients were evaluated. MAIN OUTCOME MEASURES--Use of hospital beds, psychiatric diagnosis, social functioning, patients' and relatives' satisfaction, and activity of daily living programme staff. RESULTS--Home care reduced hospital stay by 80% (median stay 6 days in home care group, 53 days in hospital group) and did not increase the number of admissions compared with hospital care. On clinical and social outcome there was a non-significant trend in favour of home care, but both groups showed big improvements. On the global adjustment scale home care patients improved by 26.8 points and the hospital group by 21.6 points (difference 5.2; 95% confidence interval--1.5 to 12). Other rating scales showed similar trends. Home care patients required a wide range of support in areas such as housing, finance, and work. Only three patients dropped out from the programme. CONCLUSIONS--Home based care may offer some slight advantages over hospital based care for patients with serious mental illness and their relatives. The care is intensive, but the low drop out rate suggests appreciation. Changes to traditional training for mental health workers are required."
Man has always been interested in predicting the outcome of various random events and at times has been prepared to risk his money, his wife and on occasions his life, on his ability to make the correct guess. There has been much speculation and concern about the effect of gambling on the national well-being, but there is little doubt that for the individual there is great satisfaction to be derived from making a correct prediction and winning something for nothing. Many charities and some governments benefit from this common desire.
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