In order to determine organic morbidity in psychiatry, 140 psychiatric inpatients (aged between 20 and 49) were examined. After various investigations (physical, biological, chest film, EEG, ECG), it was concluded that 52% of the patients suffer from at least one physical disease, and 23% suffer from more than one. The most frequent diseases are digestive (hepatic), respiratory and cardiovascular. The relationship between opiate addiction and stomatological, urogenital and dermatological diseases, and between alcoholism and liver diseases seems clear. It would appear that a medical approach adapted to psychiatric patients is necessary in order better to diagnose these physical diseases, and to reduce psychiatric overmorbidity, which might lead to a decrease in psychiatric excess mortality.
After defining the social support concept this article discusses some studies of its significance in relation to psychic functioning. Correct conception and operationlisation of social support is urged. Only then can some aspects of social support be studied in the clinical and the epidemiological perspective.
In 1968, the Veterans Administration and the National Institute of Mental Health organized a multi-hospital collaborative study on the effectiveness of lithium carbonate in acute mania. Two hundred and fifty five newly-admitted patients with this disorder were randomly assigned to lithium or chlorpromazine treatment for a three-week period. Patients were classified as highly active or mildly active on the basis of hyperactivity shown at admission. Results have been reported in a previous paper (7). Briefly, it was found that chlorpromazine was significantly superior to lithium in treating the highly active patient: chlorpromazine acted more quickly than lithium, produced significantly fewer treatment failures, and had a lower incidence of severe side effects. The difference between treatments was less clear-cut with mildly active patients, although lithium appeared to be the better treatment. Both drugs effectively reduced manic symptomatology, but lithium produced fewer severe side effects and left the patient less sluggish and fatigued. The poor results with lithium among highly active patients were attributed to the drug's relatively slow onset of action. As a group, highly active patients on lithium showed relatively little change in manic behaviour during the first week; it was ten days before some patients showed any improvement. Almost 40 per cent of the highly active patients had to be taken off lithium before the end of three weeks because of unmanageable behaviour or toxicity. In contrast, chlorpromazine, with its quick onset of action, generally controlled manic symptoms
Reviewers of the literature are unanimous that in schizophrenia the outcome is better in cases where there is a history of stress shortly before the onset of the illness. Zubin et al. (1961) found 89 papers ascribing a favourable prognostic influence to stress and none maintaining that it had a bad or immaterial effect.
The community hospital is a uniquely well suited setting for programs of preventive psychiatry. As an information center as well as a service center, it affords an opportunity for the psychiatrist to come together with other members of the medical community to initiate programs which not only will foster earlier diagnosis and more adequate treatment of psychiatric syndromes, but also will achieve other important goals as well. Whether dealing with children, adults or families, all members of the health profession can establish effective programs to strengthen the individual's ability to cope with predictable stresses, thereby reducing the likelihood of emotional decompensation. For this purpose, changes of attitude and approach are required, within the hospital group and in the relationship between the health profession and the community.
