As part of an effort to improve the detection of depression in geriatric hospitalized medical patients, the validity of two self-rating depression scales, the Zung Self-rating Depression Scale (SDS) and the Popoff Index of Depression (ID), was evaluated. These two scales were completed by 42 medical inpatients whose mean age was 68 years. A psychiatrist who was "blind" to scale results interviewed each patient and diagnosed the presence or absence of depression according to the Diagnostic and Statistical Manual-III (DSM-III) criteria for Major Depressive Episode. On both the SDS and the ID, there was significant agreement between the scale results and the interview diagnosis. Compared with the interview diagnosis, the SDS had a sensitivity of 58 per cent and a specificity of 87 per cent, and it correctly identified 74 per cent of the patients as being either depressed or nondepressed. The ID had a sensitivity of 88 per cent and a specificity of 52 per cent, and it correctly identified 66 per cent of the patients. Although performance on both scales is reduced compared with that of younger depressed patients, these self-rating scales appear to be useful aids for the detection of depression in geriatric medical patients.

This paper examines patient (N = 75) ratings of treatment satisfaction and outcome for severely mentally ill dually diagnosed outpatients participating in long-term integrated dual focus treatment. In addition, it compares these ratings with case manager ratings of patient outcome over a one year period. Satisfaction ratings ranged from very good to excellent. Combined means of several outcomes ratings indicated that most patients rated themselves as improved. Satisfaction with over-all care and with case management was significantly, though weakly (r = .3 and .31, respectively, p < .05), related to patient ratings of overall outcome. While most patients rated that they had improved, satisfaction with treatment was only weakly related to either patient or case manager rated clinical outcomes. These findings indicate the relatively independent relationship of satisfaction with treatment outcome and caution against over generalizing the meaning of treatment satisfaction measures.

Four patients with dysfunction of the central nervous system secondary to bromide intoxication are reported. Three of them were referred because of symptoms of "senility," which appeared to preclude further independent living. After diagnosis and treatment of the bromism, they were able to continue living at home. The development of bromide toxicity with relatively low serum bromide levels in the elderly is discussed. The importance of a home visit to establish the diagnosis of drug-induced cognitive dysfunction is emphasized.

The PASARR referral process detected a group of seriously mentally ill, functionally disabled patients, most of whom required the level of care that nursing homes provide. Depressed and psychiatrically impaired dementia patients were underrepresented in the referral pool as measured against widely accepted prevalence figures for mental disorders in nursing home populations. The PASARR process as currently configured appears to be most efficient in identifying schizophrenic patients, who represent a small minority of nursing home residents, and the skewed sample it generates fails to provide an adequate basis for estimating overall mental health services needed in nursing homes. The PASARR process should be altered to improve referral rates for depressed and behaviorally disturbed dementia patients.