Suicide is intentional self-killing, and parasuicide an act of deliberate self-harm—either by injury, ingestion or inhalation—not resulting in death (Blacket al,1982). Both are rare under the age of 12 and the rate of suicide in those under 16 remains consistently low. Referrals to psychiatric services reported by Shaffer (1974) indicated that 7–10% were for threatened or attempted suicide, while Hawton (1982) quoted studies giving the incidence as 10–33% for children aged six to 12; in England and Wales (1962–1968), suicide accounted for 0.6% of deaths in the 10–14 age-range. McClure (1984) found that between 1975 and 1980, only ten such deaths were recorded in the 13-and-under range, and 26 deaths in the 14 year-olds, after which the number of suicides rose sharply with each successive year. That study also showed that parasuicide was most common in the 15–24 age-group, but at younger ages there was a higher proportion of undetermined deaths, as against officially recorded suicides. The social taboos associated with suicide may lead to its systematic under-reporting, but even allowing for that, the phenomenon is still a rare one under the age of 16.

Hysteria is a topic which has produced a plethora of articles on adults but, in comparison, there is a scarcity when it involves children and young adolescents. There is considerable confusion in definition, classification, incidence and management. More agreement seems to be found when conversion reactions are specifically considered.This article attempts to present the dilemma that confronts the clinician when faced with an individual patient with a conversion reaction. This may especially apply to the present day practitioner who is likely not to have had much personal experience in managing this condition. Some of the relevant literature is summarized and the five patients are presented in tabular form and individually, together with their outcome at follow‐up. The findings are discussed and some conclusions are drawn.

ABSTRACT. A system of outcome indicators for the health and social care of ageing people with learning disabilities is required to ensure that clinicians, planners, purchasers and policy makers can monitor and evaluate the impact of health and social care. As longevity is increasing in people widi learning disabilities, special problems are found in the physical health, psychological health and social wellbeing of the elderly. This paper reviews theoretical aspects of outcome indicators, and uses the various classes of outcome measures available to draw up a system of indicators for clinicians, researchers and planners. This paper represents the personal view of the authors, prepared for a conference in August 1992.

water including that for brushing teeth; avoided milk, cheese, yoghurt, and uncooked vegetables; reduced meat and alcohol consumption; peeled all fruits; ate at the more "hygienic" expensive restaurants, where they wiped dishes and cutlery with their own dishcloth. Unsurprisingly, they endured episodes of thirst and hunger, and expense, to comply. One of them developed infectious hepatitis, bacillary dysentery, amoebic dysentery, and repeated episodes of non-specific diarrhoea. The other developed life threatening bacillary dysentery, giardiasis, two episodes of diarrhoea, and loose stools which persisted for 30 months after returning to Britain. A diet free of pathogens can rarely be achieved while travelling, particularly on a low budget trip to a developing country. Travellers need a balanced view of the costs and benefits of advice about the prevention of traveller's diarrhoea. Scientific advice should not rest solely on descriptive epidemiological studies and the principles of hygiene derived from the microbiology laboratory. Randomised controlled trials of field interventions are needed to assess efficacy in the main groups of travellers, by destination.

A study is reported of 25 cases aged 11 to 15 years, referred to a special clinic and treated on a conditioning programme using the auditory alarm technique followed by a period of ‘over‐learning”, found to be effective in reducing relapse rates. The management is described in detail and potential problems for the individual are considered as well as the results obtained for the group as a whole.