Although the number of anti-depressant drugs available has grown rapidly in recent years, they are still broadly classified into three main groups. First are the general nervous system stimulants, exemplified by amphetamine, second the group derived from the phenothiazines exemplified by imipramine and third, the monoamineoxidase inhibitors—the first example of which was iproniazid. The general stimulants have many disadvantages, their place in treatment is limited, but fairly well defined. Many monoamineoxidase inhibitors have been found to have serious toxic effects, but some, including tranylcypromine appear to be reasonably safe and effective (Agin, 1960).
During the past ten years much attention has been paid to the question of chronicity in mental hospital patients. At the same time there has been a trend towards establishing units (often attached to general hospitals) for short-stay in-patient and possibly day-patient care. In these units, where the emphasis is on outpatient treatment, it is soon apparent to the psychiatrists staffing them that they, too, have to cope with a population of chronic patients. They tend, however, to be outpatients rather than in-patients, and are probably better described as “long-term”. Heasman (1962) gave a graphic description of this problem in the non-psychiatric outpatient department and compared it to that of the “institutional neurosis” as described by Barton (1959). The purpose of this paper is to describe the situation in a Teaching Hospital Department of Psychiatry attached to a general hospital.
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