Working as a doctor or dentist may entail higher levels of stress than are experienced by the general population. In some situations adding in the role of teacher reduces this stress, but more research is needed to explain this finding.

Objective-To determine the accuracy of psychiatric diagnoses made by two community psychogeriatric teams operating a multidisciplinary assessment procedure.Design-Comparison of team diagnosis with independent formal assessment and consensus diagnosis by research psychiatrists.Setting-Two community psychogeriatric teams with similar operational policies in an inner London health district.Subjects-100 people aged 65-90 (70 women) newly referred to the teams.Main outcome measures-Concordance between team and research diagnoses.Results-Agreement between team and research diagnoses ranged from 90% to 99% for the specific psychiatric disorders studied. There was no significant difference between medical and non-medical team members in their diagnostic performance compared with the research psychiatrists. Increased diagnostic accuracy by team members was associated with longer experience ofteam working, regardless ofthe team members' professional background.Conclusions-The multidisciplinary approach to the assessment of referrals to these community teams for the elderly is not associated with misdiagnosis ofpsychiatric disorder.

No abstract

SUMMARYThis study reports a cross-sectional comparison between three continuing care facilities for severely disturbed elderly demented people: two mental hospital psychogeriatric wards and a unit run according to the domus philosophy of care. The domus was characterized by greater expectations for residents' functioning, policy choice, resident control and availability of social and recreational activities. The level of staffing was higher on the domus than on the two wards. The residents on the three settings were broadly comparable with regard to age, diagnosis, length of stay, objectively assessed cognitive impairment and depression, but the domus residents were rated by the staff as less disabled in self-care tasks, orientation and communication. Direct non-participant observation using the Short Observation Method demonstrated significantly higher levels of activities and staff-resident interaction on the domus compared to the hospital wards. There were no differences between the settings with regard to staff absenteeism, job turnover or psychological impairment, but the domus staff expressed higher levels of job satisfaction. These findings are discussed in the context of the limitations of study design and method.KEY woms-Domus, nursing home environments, dementia, quality of care.

A retrospective case-note survey was carried out on 31 subjects admitted with temporal-lobe epilepsy to the Maudsley hospital from 1974-1983 inclusive. Fourteen aggressive subjects were compared with the non-aggressive patients on 95 organic, developmental, and social variables. Aggressive behaviour was associated with male sex, early onset of seizures, and a history of long-standing behavioural problems. Aggressive subjects had lower mean IQ scores and poorer occupational records than controls. No relationship was found between aggression and the presence of specific EEG or CAT scan findings, or a history of psychosis. The results demonstrate the complex interplay between organic and socially mediated factors underlying aggressive behaviour in temporal-lobe epilepsy.