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This report describes rates of outpatient psychiatric clinic usage for various demographic groups in the United States by age, including single years for children, sex, color and marital status. Major and detailed psychiatric diagnoses are also investigated. These data come from the national reporting program on outpatient psychiatric clinics and the 1960 census information. Differences by geographic region are also described.

On the basis of 8 months' experience with this small group of 5 physicians, it does appear feasible to instruct general practitioners in the psychiatric management of the chronic alcohol patient. It seems that such a program of instruction presents certain unique problems, primarily the limitation on the time the general practitioner can spend away from his practice. This difficulty can be met in part by brief periods of instruction and by films produced specifically for the general practitioner. This conserves staff time and provides a means of instructing small groups in a scheduled manner. The following advantages to such a program of instruction are seen: the physician's interest is maintained by his treating patients during an extended period of instruction, and he becomes known in his community as one who will accept alcoholic patients and has some instruction in their management. This method of providing treatment in professionally isolated areas appears to have the following advantages as compared...

Out-patient services in Britain for psychiatric patients have expanded enormously under the National Health Service. Well over half a million patients are seen at clinics annually. Concomitant with this increase the out-patient department has changed in function. No longer is it principally concerned with providing follow up and support for discharged mental hospital in-patients; instead, because of the greatly increased demand for psychiatric care for less severe disorders and under the influence of the movement for community care it now should play a part not at all subservient to the in-patient department. The clinic, properly run, should be an arena of treatment in its own right.

Introduction:Age-related macular degeneration (ARMD) is a leading cause of blindness in the elderly population. Objective:To frame a profile of patients with ARMD and find out the factors associated with it Materials and methods: A cross-sectional study was carried out including a total of 75 patients with ARMD presenting to the out-patient department of a tertiary level ophthalmic center in Kathmandu. The data pertaining to their demography, ocular and systemic history and the findings of clinical examination and laboratory investigations were analyzed. The quality of life was assessed based on their dependability on the others for daily activity. Results: Mean age of presentation of ARMD was 73 years ±7.93. Of the total, 44 were male and 31 female. Smoking was significantly associated with ARMD (p

Summary The development of isoniazid resistance accompanied by radiographic or bacteriological evidence of relapse has been investigated in a series of 12 out-patients prescribed apparently adequate combinations of sodium PAS and isoniazid dispensed in the same cachet. The emergence of drug resistance was believed to be due to irregular ingestion of the cachets. If relapse, for which there is no other satisfactory explanation, occurs during treatment with sodium PAS and isoniazid in adequate dosages, the drugs should be discontinued temperarily until sensitivity results are obtained. Otherwise loss of sensitivity to PAS may also develop, as occurred in 4 of the 12 individuals in this series.

1. With skilled and positively directed psychotherapy and a well-integrated clinic setup, the veteran patient suffering from service-connected psychoneurotic disorder may be expected to be supporting himself and working each day after a period of 12 weeks of treatment (12 interviews). 2. The patient whose neurotic symptoms are an expression of emotional instability based on life-long faulty habit patterns may also be expected to respond favorably if well motivated. Thirty-two of 47 such patients in this group are working and have gained healthful insight into the emotional nature of their symptoms through psychotherapy. 3. Schizophrenic patients may be carried along on an outpatient basis providing they have partial insight and are not too unpredictably aggressive. 4. From the standpoint of recovery it can be said that adequate outpatient care is the first step to be taken in any treatment effort directed to restore the veteran patient to healthy relationships with his family and the community.

The day hospital is one of a series of experiments in devising new psychiatric treatment settings. It has been a useful and productive development. The models created in different centres differ widely in their general applicability, their clinical usefulness, and their theoretical interest. The first day hospital was set up at the Allan Memorial Institute in 1946, and in 1958 was reorganized to provide services in combinations matched to the individual patients and readily varied as necessary. Coincidentally a re-examination of its social structure led to an activity program which produced marked changes. These changes not only remedied current difficulties operating the day hospital but also greatly extended its range of usefulness.

A group of 452 discharged tuberculosis patients was presented with results of post-hospital chemotherapy. It was found that relapse and mortality were higher in those patients who had interrupted their treatment, and that the prognosis of even irregularly discharged patients was good if they continued chemotherapy faithfully.

A food formula (Metrecal) has been successfully employed as the sole or major source of sodium and calories in the management of 17 patients with congestive heart failure and 3 patients with lymphedema. This preparation supplies 900 mg. of sodium, 70 Gm. of protein, and 900 calories per quart. Obesity was not a factor in 11 of these individuals. Gratifying diuresis in a patient with anasarca due to carcinomatosis also is cited. The advantages of this diet over other low-sodium regimens—with particular reference to the standard or modified Karell diet and the rice diet—include the following: (1) its palatability, acceptability, convenience, and relatively low cost; (2) the insuring of an adequate intake of protein, calories, vitamins, and minerals; (3) the minimizing of postdiuretic asthenia; (4) the frequent reduction in oral and parenteral diuretic requirements; (5) the high buffering capacity against gastric acidity; (6) the minimizing of hypoglycemia and edema that can occur after excessive ingestion of carbohydrate in patients who are subject to recurrent hypoglycemia; (7) the absence of “anticoagulant escape” in patients being concomitantly maintained on long-term anticoagulant therapy; (8) its effectiveness as an outpatient dietetic regimen—in conjunction with digitalis, diuretic agents, local treatment to the lower limbs, and other standard measures—in preventing hospitalization; (9) the significant reduction in hypercholesterolemia; and (10) its effectiveness in initiating long-term weight reduction when the patient is obese as well as edematous. The last feature is especially advantageous in those cardiac patients whose caloric expenditure cannot be safely increased by exercise. In several patients a significant diuresis was induced after digitalis, oral and parenteral diuretics, adrenocortical steroids, and even spironolactone had failed to reduce edema. In 4 patients it was not necessary to resort to spironolactone when its use was being contemplated because of a prompt diuresis after treatment with the sodium-poor formula. Two patients with anasarca appeared to have a potentiated diuretic response when the formula diet and spironolactone were administered together.

In this comparative trial of isocarboxazid, tranylcypromine, imipramine and amitriptyline in out-patient cases of depression our results for the initial period indicate that: 1. As a group patients with depressive personality reactions do not respond to out-patient anti-depressive medication. 2. With patients showing endogenous pattern of mood change, there is a greater initial improvement rate with the mono-amine-oxidase inhibitors than with the imipramine group of drugs. 3. Although the two mono-amine-oxidase inhibitors were more or less equal in anti-depressant potency, there was a higher incidence of severe side-effects with tranylcypromine.

One hundred medical out-patients had psychiatric interviews at their first attendance. When investigations had been completed they were divided into two groups; 45 per cent. had a structural lesion to account for their symptoms, and 55 per cent. were functional, no such lesion having been demonstrated. The two groups were compared statistically for various factors. The functional group of patients was younger; less incapacitated; had seen their G.P. fewer times prior to referral; and were more likely to have been investigated elsewhere for the same complaint. Abnormal physical signs were found almost exclusively in the structural group. The overall incidence of mental disorder, using a narrow definition, was 26 per cent.: it was significantly commoner in the functional group and more of these patients considered themselves to be nervous. No significant differences were found in the social or family background or in the past medical or psychiatric history.

Summary Outpatient group therapy experience with geriatric patients has been described. The psychologic problems of the aged have been reviewed as well as the ways in which they resemble and differ from those of other age groups. A review is presented of previous therapy experiences with older patients both in individual and institutional milieu settings. The presenting symptoms of the group members described herein have been summarized. A synopsis has been given of therapy sessions at different stages in the evolution of the group. Implications for this approach as an effective means of coping with the therapeutic needs of the geriatric population have been discussed.

Barbiturates arc commonly used in treating anxious, disturbed patients. Well controlled trials have shown that at least amylobarbitone (‘Amytal’) is therapeutically active (Scott, 1955; Raymond, Lucas, Beesley, O'Connell and Fraser Roberts, 1957; Robin, 1959), and that a newer barbiturate, nealbarbitone (‘Censedal’) is, weight for weight, equally effective (Robin, Cronin and Scotton, 1961). Since nealbarbitone is less hypnotic (Ryde, 1959; Hinton, 1963), it may be used in larger doses than are expedient with amylobarbitone, and this could make it more useful in controlling anxiety. Phenobarbitone is widely used, especially in general practice, to relieve symptoms of anxiety. Its activity in experimental animals, for example in preventing electrically induced convulsions without causing sleep, differs considerably from that of amylobarbitone (Merritt and Putnam, 1938), but it appears not to have been compared directly with amylobarbitone in a controlled clinical trial upon patients with anxiety.

Two populations of psychiatric outpatients totalling 109 were given placebos and the effect on their reported level of distress noted immediately and after 1 and 2 weeks on the placebo. Patients in both populations received special tests and measures before and after receiving placebo. Over half the patients in each group were re-examined after 3 and 2 years respectively, at which time some again received a placebo. In both groups, whatever the criterion used or the time interval, a greater proportion of patients reported improvement than reported getting worse. The mean discomfort score dropped sharply during the first interview, before as well as after administration of the placebo, then tended to increase, but not back to the initial level. Maintenance on placebo did not increase the effect. The amount of improvement was related to amount of distress reported initially, and symptoms of anxiety and depression showed more improvement than somatic ones. Patients showed little consistency in their responsi...

The treatment of two groups of paranoid schizophrenic patients with group psychotherapy was approached with the following goals in mind: (1) to maintain a group in treatment on an out-patient basis by means of ego supportive psychotherapy and drugs as necessary; (2) to help patients within the group to achieve more successful or healthy adjustments to social, family, and employment relationships by means of the group process.