The 60-item GHQ was validated in a community population by comparison with the CIS. The GHQ failed to identify nearly half of the psychiatric 'cases' in this population. Those missed were similar to those detected except for greater chronicity of illness and more frequent social and interpersonal problems. The GHQ appears to be unsuitable as a screening instrument for mental illness in the community and the possible reasons are discussed. Principal components and analysis resulted in a 15-item GHQ factor which, when used with Likert scoring, resulted in considerable improvement and failed to identify only 4 per cent of 'cases'. It is suggested that this may prove a more satisfactory screening instrument.

In a single-blind, randomised, crossover study in 10 asthmatic patients, the effects of approximately equipotent oral doses of 3 cardioselective beta-blockers-atenolol (100 mg), metoprolol (100 mg), and acebutolol (300 mg)-and 4 non-cardioselective beta-blockers-proranolol (100 mg), oxprenolol (100 mg), pindolol (5 mg), and timolol (10 mg) upon FEV1 were compared. All drugs, except pindolol, produced a significant reduction in standing pulse rate and prevented an increase in heart rate after inhaled isoprenaline (1500 microgram). All drugs caused a fall in FEV1 but only atenolol did not differ significantly from placebo in this respect. The bronchodilator response to inhaled isoprenaline was blocked by the 4 non-cardioselective drugs; the 3 cardioselective agents permitted some bronchodilatation, but only atenolol did not differ from placebo.

SUMMARYA 70-year-old man with a history of peripheral vascular disease was treated initially with antidepressants, then bilateral electroconvulsive therapy (ECT) for a depressive illness. Apart from an episode of delirium following ECT he recovered fully. Four years later he relapsed. Low-dose antidepressants caused disorientation and oversedation, as did ECT. Shortly afterwards he developed a multi-infarct state with Parkinsonian symptoms, transient ischaemic attacks (TIAs) and cerebrovascular attacks (CVAs). His cognitive deficits implicated pathology in the frontal and subcortical areas of the brain. Postmortem examination confirmed widespread atherosclerotic disease, also cerebrovascular disease. The haemodynamic and cerebral effects of ECT are considered in the context of vascular disease. It is postulated that ECT given to such patients might cause permanent impairment of cognitive function through ischaemia of an already compromised cerebral circulation. Suggestions are outlined regarding a policy for a more comprehensive assessment of patients with atherosclerotic disease. Deficiencies of ECT procedures are highlighted.KEY woms-Electroconvulsive therapy, ECT, elderly, multi-infarct dementia, delirium.Mr G initially presented with depressive illness at the age of 70. His medical history included intermittent claudication. His mother had suffered from long-standing cardiac disease and died at the age of 66. He was a non-drinker and non-smoker. As his depression failed to improve on standard doses of mianserin and prothiaden, he was admitted for electroconvulsive therapy (ECT). Cardiovascular evaluation was normal. Following the fourth ECT he became disorientated with perseveration, disinhibition and aggression. This resolved over the next 2 days with phenothiazines. He was given one further bilateral ECT before being discharged on parstelin (compound tranylcypromine/trifuoperazine). Two months later he was readmitted with a relapse of depressive illness. Cognitive function tests were performed in detail but no impairment was demonstrated. Physical examination, routine blood tests, electrocardiograph (ECG) and chest X-ray (CXR) were all normal. ECT again resulted in delirium, this time after the ninth application. Mental state gradually improved as before. A computerized tomography (CT) scan was reported as normal. Six further ECTs were given without incident, and the patient was discharged improved in mood on lithium 1 g daily.Four years later (aged 74) Mr G again became depressed. Physically he complained of painful legs. An arteriogram showed calcification of the abdominal aorta and iliac arteries. Over the next 2 years his mood worsened, despite his receiving a range of antidepressants which included lithium, tricyclics and 5HT antagonists. Very low doses of all drugs resulted in oversedation and disorientation. Right unilateral ECT was given. Each one of the 12 treatments was followed by prolonged anaesthetic recovery, daytime drowsiness and confusion. Two months later a number of investigations were pe...