A 5-year follow-up study was carried out of all referrals to the psychiatric services in a Regional Board area. The death registers of the Registrar General for Scotland were searched for all patients who were not known to be alive at the end of the study. Of the 2103 patients included in the original study, 343 were found to have died. This represents 15.9 per cent of males and 16.7 per cent of females referred. Most of the deaths (41%) occurred in the first year of follow-up, 20 per cent in the first 3 months. The overall death rate was approximately twice the expectation based on death rates in the general population of the area. The excess was greatest in those aged under 55 years. All areas of residence, occupations and social classes had increased mortality. Those patients diagnosed as organic psychosis had highest mortality (70%) but all diagnoses had an excessive number of deaths when standardised for age. Of the initial referrals, 1.4 per cent committed suicide during the follow-up period. Apart from neoplasms where deaths were close to expectation, all other broad categories of causes of death were equally involved in the increase. This survey of a total psychiatric referral group (in-patients, out-patients and domiciliary visits and private patients) supports previously reported studies, mainly of in-patients, in their finding of an association between high mortality rates and psychiatric illness. It is possible that this association may result from selective referral to the psychiatric services of those psychiatrically ill patients who exhibit physical symptomatology.
Prevalence studies of mental subnormality among regional populations are few. Detailed epidemiological enquiries have been carried out in the regions of Northern Ireland (Scally and MacKay, 1964), Wessex (Kushlick, 1965) and, for severe mental subnormality in children, in Middlesex and London (Goodman and Tizard, 1962). The North-East Region of Scotland is especially suitable for epidemiological studies in psychiatric morbidity by reason of its geography, demography and centralization of psychiatric services (Innes and Sharp, 1962; Baldwin and Millar, 1964). A Regional Psychiatric Case Register giving rapid access to social and clinical information on all patients is fully operational (Baldwinet al., 1965). Using this facility as a primary source of data, a prevalence study of mental subnormality among the half million population of the North-East of Scotland was carried out. The objects of the study were three-fold: first and primarily, to establish case rates for known subnormality, examine patterns of morbidity and the factors that influence this and to compare these with the findings of similar epidemiological studies; second, to gain operational data relevant to existing practice, needs and planning of services; third, to provide a data bank within the Regional Psychiatric Case Register for mounting detailed clinical, genetical, social or biochemical studies on an area population of subnormal patients.
Objective-To record every patient with proved colorectal adenocarcinoma presenting from a defined population over two years in 1968-9 and during 1980-2, and to compare treatment and outcome over seven years. Design-Retrospective in 1968-9 and prospective in 1980-2. Setting-Aberdeen general hospitals.Subjects-Every patient presenting to the four general surgical units with histological proof of colorectal adenocarcinoma.Main findings-On average, one new patient presented each week per 100000 population. The proportion of patients aged 65 and over rose from 67% to 71%. An operation was performed on 385 patients in 1968-9 and on 399 during 1980-2. At laparotomy the proportion of patients who seemed to be curable and had a radical operation rose slightly, from 56% to 61%, and operative mortality fell from 9% to 5%. In all there were 421 survivors of curative surgery, and seven years later three quarters were either alive (51%) or had died without recurrence (25%). In both studies some 40% of patients were considered incurable when they presented, but the number who had a palliative resection rose from 59% to 85%.Conclusions-The contribution of radical surgery to the treatment of colorectal adenocarcinoma is substantial, with three quarters ofpatients so treated showing no evidence ofrecurrence after seven years. Operative mortality in an elderly population is now low, and improvement in late outcome is more likely to come from developments in adjuvant therapy than in operative technique. A continuing problem is that 40% of patients are not curable when they present, although palliative resection can now be offered to over 80%. IntroductionCarcinoma of the large bowel is the neoplasm most often treated by general surgeons. Its management is now receiving much attention, with reports opening with the statement that over 20000 people die each year in Britain from this cause and that five year survival is less than 30%.' These figures very properly attract attention, but two surveys of the population of northeastem Scotland suggest that, for several reasons, they need careful interpretation.More than half of the patients who now present are 70 or more years of age, so causes of death natural to an elderly population will account for considerable late mortality. Secondly, results are seriously affected by the fact that 40% of patients are beyond hope of cure when they present, and virtually all die within three years. Finally, although radical surgery is often successful in patients who seem to be curable at the time of operation, follow up reveals that occult local or distant spread was already present in one
The general aim of the experiment was to discover whether, during an interview directed at discussing the patient's life, there was any significant alteration of blood-pressure, heart rate or brain waves in association with emotional content; as it turned out, changes in blood-pressure proved to be the most rewarding field for study and in consequence this aspect was accorded more attention.
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