Objective: The objective of the present study was to examine the use of medication in an elderly psychiatric inpatient population.Method: This was a retrospective survey of medication prescribed to the total elderly inpatient population of a single psychiatric hospital. Data collected included basic sociodemographic information, length of stay, number of admissions, frequency of psychiatric disturbance, diagnosis and medication prescribed.Results: A total of 340 cases were studied, 229 (67%) were female, 324 (95%) had been inpatients for more than one year, 111 (33%) suffered from dementia, while the remainder were in the functional category. In 57% more than one psychotropic drug was used. Over half (56%) of those with dementia were on neuroleptic medication.Conclusion: Psychotropic polypharmacy was found in this population of elderly patients. Management issues emphasised include the risk of polypharmacy in this age group, the need for staff education, an active pharmacy committee and alternative methods of managing behavioural disturbance in elderly patients in particular those with dementia.

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They also gave another example wherein it is sup posed that schizophrenia results from defects in a pathway of brain function. A complete mutation in the gene controlling a step of this pathway would result in a phenotype, the failure of development of brain function being manifest as schizophrenia.We agree with this proposition, but want to look at it from another angle. Instead of postulating that the altered genes on one or more chromosomes produce an end effect of reduction in the amount of protein (for example an enzyme of a pathway), we can say that the end result of the mutation on a single gene acting on its own or the mutations on several genes acting in union would cause an increase ratherthan a decrease in the amount of protein (again an enzyme). We can cite the example of acute intermittent por phyria where the activity of the hepatic delta-amino laevulinic acid synthetase is increased several fold (Dewar, 1988). Another example is Huntington's chorea in which it has been shown that there are increased dopamine concentrations in parts of basal ganglia (Gelder et a!, 1989). This possibility of increase in protein would be in conformity with the dopamine hypothesis where the dopamine-like effect is supposed to be increased. What we mean to led them to conclude that all-female sibships were significantly over-represented. This conclusion is based on dubious statistical reasoning. Only female bulimics were included in the study, and the authors have underestimated the impact that this will have had on the likelihood of all-female sibships. For example, in the case of a sibship of two (i.e. the female proband and just one brother or sister), the authors claim that the expected proportion of all-girl sibships is one-third. This is a surprisingclaim since having a brother and having a sister should be equally likely (provided one ignores the slight excess of boys in the general population), leading to an expected pro portion of one half. The authors' expectation that chance alone will result in bulimic women having strikingly more brothers than sisters seems no better founded than the expectation that normal women will typically have more brothers than sisters, or that normal men will typically have more sisters than brothers.