Almost none of those with anxiety disorders were being treated for them, primarily because the severity of the acute psychotic illness required full diagnostic and therapeutic attention. Patients were generally discharged as soon as their psychotic episode was resolved, with little recognition of the presence of an anxiety disorder. Given that anxiety disorders are relatively responsive to treatment, greater awareness of their comorbidity with psychosis should yield worthwhile clinical benefits.

Fifty-three psychiatric hospital inpatients with a dual diagnosis of substance abuse and schizophrenia were given the Brief Symptom Inventory and the Schizophrenia/Substance Abuse Interview Schedule. Mean age was 29; 49 were men. Only 11% were employed. Forty percent abused mainly alcohol, 40% cannabis and 8% amphetamines; 20% abused more than one substance. Mean onset age of drug abuse was 16 years; schizophrenia was diagnosed a mean of 5 years later, and subjects had been admitted to hospital an average of 7 times since then. Most believed that drug abuse initiated or exacerbated their schizophrenia; 80% took drugs primarily to relieve dysphoria and anxiety. Amphetamines improved subjective well-being significantly more than alcohol, but choice of drugs was determined mainly by price and availability. Only cannabis increased positive symptoms of schizophrenia and only amphetamines reduced negative ones. Effectively treating this population requires an integration of psychiatric and drug treatment services, ideally in a community context.

Psychiatric patients with persistent systematized delusions in the absence of major behavioural abnormalities have been traditionally regarded as largely inaccessible to verbal modes of treatment. This viewpoint is summarized in a standard textbook of psychiatry (Slater & Roth, 1969): ‘… it is a waste of time to argue with a paranoid patient about his delusions…’. Because of such views, and the related emphasis on a pharmacological approach, there is little to guide the clinician in his verbal dealings with patients in whom systematized delusions are the main feature. In contrast to the traditional view, Watts, Powell & Austin (1973) obtained significant changes in the delusional beliefs of three chronic paranoid schizophrenics after less than six hours of verbal intervention. Their procedure was designed to avoid direction confrontation, since they believed that this would induce ‘psychological reactance’ (Brehm, 1966) and might increase, rather than decrease, the strength of the delusions. They were unable to test this hypothesis. The present study aims to examine the effects of two contrasting types of verbal intervention in a larger sample of persistently deluded patients. It was predicted that (i) both interventions will reduce the strength of delusions and (ii) confrontation will produce less change in delusions and any associated behavioural abnormalities than belief modification.

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Four hundred and twenty-five nurses working in a 420 bed metropolitan psychiatric hospital were asked to complete a questionnaire about their experience of physical assault by patients and their attitude toward the problem. 61% returned the questionnaire. The overall mean annual rate of assault per nurse was 2.0, with student psychiatric nurses (mean 6.7) significantly more at risk than any other group. Nurses working in the psychogeriatric area reported more than double the rate of assaults reported by nurses working in rehabilitation services. 60% of respondents were female; there were very few sex differences in attitudes to assault. Overall, nurses reported a high tolerance for assault, although they recognised it as an experience that was often very traumatic psychologically. Views about managing assaultiveness differed widely, and this lack of consensus probably hinders the development of optimal strategies to deal with what is a major problem in many psychiatric units.