There remain problems with satisfaction scales. Qualitative approaches to examine patients' experiences in hospital and the causes of dissatisfaction are recommended.

Three-hundred-and-twenty-seven male and 323 female medical and geriatric admissions over the age of 65 were interviewed about their drinking habits. Thirty (9%) of the men were found to drink in excess of the Royal College of Psychiatrists' recommended safety limits. The majority of these were lifelong heavy drinkers. Another 33 (10%) had previously drunk heavily over the age of 65, but had cut down, the majority spontaneously. Alcohol usage among women was less, although there was strong circumstantial evidence of heavy usage in a few. Twenty-five of the 30 men identified above as 'at risk' were interviewed in greater depth. These were compared with 25 age-matched light drinkers or non-drinkers. Forty-eight per cent of the men admitted to one or more alcohol related problem and if the admission diagnosis were included the number rose to 60%. The 'at risk' drinkers were significantly more likely to smoke, not to be married and to have some impairment of mobility.

No abstract

Although acute and immediate extrapyramidal syndromes are common and, in the case of neuroleptic malignant syndrome, may have serious sequelae, the most important problem with psychotropic medication in schizophrenia remains the tardive movement disorders. These are increasingly recognised as being aetiologically as well as symptomatically heterogeneous. Although risk factors are being identified with greater clarity, there is little in the way of effective treatment. This suggests that clinicians must embark on long term neuroleptic treatment with vigilance. Clozapine alone has few extrapyramidal effects, and has been described in isolated instances as improving established movement disorders. However, haematological idiosyncrasies will preclude its use in all where compliance is uncertain. Its superior efficacy will hopefully give impetus to research into safer analogues.