Fifty-six consecutively admitted elderly (65 and over) patients with depression were assessed on mental, physical and social states. They were followed up and assessed at home one year later. A group of 24 depressed in-patients aged under 65 years admitted to the same ward during the same period was also assessed. Outcome was different for the two groups, with 68% of the elderly 'well' at one year, against 50% of the younger group. The younger group were more likely to have 'poor' outcome (41%) than the elderly (16%). However, there were more deaths than expected, particularly in the elderly. These findings differ from some previous studies, and indicate an excellent prognosis for depression in the elderly. Outcome in younger patients is less good.

There has been renewed interest in suicide with the Royal College of Psychiatrists' con fidential enquiry into suicides, and the publication of the government White Paper The Health of the Nation (Department of Health, 1992). Prevention of suicide depends on accurate understanding of the factors leading to suicide. Barraclough et als (1974) influential study found that the vast majority of completed suicides were mentally ill and most had had some contact with a doctor in the previous month, so that there was "no lack of opportunities for their suicidal intentions to be recognised and treated". However, since that study there have been changes in the structure of the population and increases in the numbers of younger men committing suicide (McClure, 1987). We therefore set out to obtain a more up-to-date view by examining all suicides within our catchment area, looking at their consulting behaviour, and whether there was any alienation from partners, rela tives or others. The studyWe searched the coroners' records from 1988 to 1991 inclusive, for all suicide, open and misadventure verdicts of residents of our catchment area, and made summaries. The population of 305000 lives mainly in small towns, with a third being rural agricultural. As a cross-check we also had available a list of suicides and undetermined injury (ICD E950-959 + E980-989) obtained from death certifi cate returns to the Director of Public Health. Hospital records were obtained for all those known to psychiatric services, and general practitioner notes were obtained through the relevant Family Health Service Authorities for 101 of the 112 suicides. These were searched for details of contacts with services in the year before death. The main clinical feature of each case was classed as either psychiatric disor der, physical illness or social distress. This was a subjective consensus of all eight con sultant psychiatrists. Cases in which social problems were associated with conditions such as chronic depression, alcoholism or personality disorder were classed as psychia tric disorder. We examined the coroners' records for any indications of alienation, look ing for breakdown or lack of relationships with family, friends or professionals. Examples included ending of a relationship, divorce proceedings, having no friends, or other evi dence of rejection of or by others.Two control cases were obtained for each suicide for whom we had obtained the GPs' notes. They were drawn from the same prac tices by searching the age-sex registers for the two closest in age and of the same sex. The notes were searched for the number of face-toface consultations in the year before the death of the index case together with the main symptoms at the latest consultation before the index case date of death. FindingsIn 87 cases the coroners' verdict was suicide and 25 open verdicts appeared clinically to be suicides, a total of 112 (or 9.2 per IO5 total population per year). There were 82 men and 666

There is an increasing momentum for the provision of care for people with chronic mental illness to be made in settings other than mental hospitals. One concern arising from this shift in emphasis is with those patients who may find it particularly difficult to live in the community.

An elderly woman who presented with a manic depressive psychosis and the narcolepsy-cataplexy syndrome is described. Cataplexy occurred only during hypomania. Other narcoleptic symptoms were more evident during depression. We are not aware of previous reports of an interaction between these two conditions, which is of considerable interest.