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France associated with bovine chlamydial pneumonia, andrising antibody titres in Californian veterinarians in contactwith bovine encephalomyelitis. Stepanek et al,7 describingserological changes associated with bovine chlamydiosis incattle and man in Czechoslovakia, note an association

between urogenital infection in men and women who havebeen in contact with cattle infected with C psittaci.The chlamydial keratoconjunctivitis agent commonly

infects domestic cats.5,8,9 An antigenically distinct agent isresponsible for the often fatal feline pneumonitis.1O Bothagents may be sexually transmissible. It is not surprising thatcases of conjunctivitis in man caused by the feline

’ keratoconjunctivitis agent are well documented.5 Regan,’

Dathan, and Treharnell described a case of infectiveendocarditis and glomerulonephritis, probably caused by thefeline keratoconjunctivitis agent.

, The diagnosis of many of these apparent cases of psittacosis; in man is based on a four-fold rise in the CF titre; some

workers regard a single high titre as diagnostic. This testmakes use of an acidic polysaccharide with group specificity,so it cannot distinguish between C trachomatis and C psittaci

: infection. Chlamydial antibody levels in the generalpopulation are high, and vary between geographical regions.The source of this antibody is unknown, but could be of C

, psittaci, C trachomatis, or even an anamnestic origin.Chlamydial infections are complex, and serological diagnosis

. is notoriously unreliable.12 Nevertheless, it is clear that

_

traditional ideas of the source of C psittaci infections require, reappraisal, and that non-avian sources and human-to-human

transmission must be considered.

MENTAL ILLNESS IN PRIMARY CARE SETTINGS

AN unusual two day conference took place at the Institute ofPsychiatry on July 16/17, organised by the General PracticeResearch Unit on behalf of the Department of Health andSocial Security. The purpose was to examine policiesconcerning services for the mentally ill in primary caresettings. Policy makers participated and most sessionsincluded general practitioners and psychiatric researchers.(The emphasis on policy rather than statements of researchfindings resulted in a meeting of monotonous consistency,

rather like a meal consisting entirely of soup.)The session on classification began with a plea from Prof A.

Clare for a new taxonomy of minor disorder attuned to theneeds of the family doctor and other members of his team, andwhich corresponds to the untidy combinations of symptomsof depression, anxiety, and somatic symptoms that are socommon in this setting. The patients often view themselvesas non-specifically ill, and seek help for physical symptoms.Dr D. L. Crombie presented data from the latest NationalMorbidity Study which seemed to indicate such wide

variability in the way psychological labels are used in practicethat a biometrician in the audience asked whether the

7 Stěpanek O, Jindichova J, Horaček J, Krpata V. Chlamydiosis in cattle and in man anepidemiologic and serologic study J Hyg Epidemiol Microbiol Immunol 1983, 27:445-59.

8 Darougar S, Monnickendam MA, El-Sheikh H, Treharne JD, Woodland RM, JonesBR. In non-gonococcal urethritis and related infections Washington DC: AmericanSociety for Microbiology, 1977: 186-98

9 Wills J, Gruffydd-Jones TJ, Richmond S, Paul ID. Isolation of C psittaci from cases ofconjunctivitis in a colony of cats Vet Rec 1984; 114: 344-46

10. Johnson FWA. Isolation of C psittaci from nasal and conjunctival exudate ofa domesticcat. Vet Rec 1984; 114: 342-44.

11. Regan RJ, Datnan JRE, Treharne JD. Infective endocarditis with glomerulonephritisassociated with cat chlamydia (C psittaci) infection. Br Heart J 1979; 42: 349-52

12 Treharne JD, Forsey T, Thomas BJ. Chlamydial serology. Br Med Bull 1983; 39:187-93

information was not of such low validity as to be worthless.The chairman of this session, himself a biostatistician,grumpily called the questioner to order, and declared thatresults of Dr Crombie’s study were useful for briefingMinisters, and that "there was a message in theresomewhere". However, his example of such a message-thehigh prevalence of anxiety in those of high social class-wasnot one that had been heard before by his distinguishedaudience. Many speakers called for a multidimensional

system rather than one consisting of mutually exclusivecategories: as Dr J. Tower put it, "we need the furtherdevelopment of a language to describe our patients".The session on screening saw research psychiatrists

pleading for the use of cost-benefit analysis to study theeffects of detecting psychiatric illnesses that would otherwisehave been treated as physical illnesses-the costs of thescreening procedure and treatment of such illnesses to beoffset against the costs of the investigations and treatmentthat the patients would otherwise have received. DrP. Williams argued for a distinction between screening andcase-finding, but Dr J. Fry remained an unreformed scepticdespite having his attention drawn to evidence of the efficacyof screening questionnaires.Dr J. Horder and Prof M. Jefferys both gave thoughtful

presentations on the professional roles of team members; andin the session that followed the relative dearth of research

findings in this area was more than made up for by bravurapresentations on studies of treatment effectiveness by ProfG. W. Ashcroft and Prof E. S. Paykel. Dr A. Ryle and ProfM. Shepherd diverted the audience by locking horns on thesubject of the effectiveness of psychotherapy, a feeling ofdeja-entendu being shattered when Shepherd declared aninterest in placebology, and asserted that the DHSS mightfind this a cost-effective form of inquiry.Dr G. M. Strathdee surprised most of her audience with the

information that one-fifth of British consultant psychiatristsnow practise regularly in primary care settings, and that thenumbers appear to be rising steadily despite the fact that therehave been no earnest directives from College or DHSS urgingthem to conduct such work. She listed advantages from theviewpoints of the consultants, the family doctors, and notleast the patients. It was left to Dr P. Tyrer, himself abeliever, to list some of the disadvantages of such liaisonattachments. These included decreased medical cover at the

hospital, an increase of "unnecessary" work, and no longerbeing able to give oneself the airs and graces of the hospitalconsultant.

Presentations by speakers from the National Institute ofMental Health and the World Health Organisation causedProf J. E. Cooper to consider the paradox that the USA, withan atrocious primary care system, spends a great deal ofmoney on research while Britain, with what must be the best

system in the world, spends very little. Dr N. Sartorius of theMental Health Division of WHO declared that there was noconsensus about the meaning of either mental health orprimary care: each country means something entirelydifferent by the terms.

Closing the conference, Professor Shepherd said that 10years ago official thinking was that there existed policymakers who were able to formulate their needs, and scientistswho were able to satisfy these needs under contract. It wasnow appreciated that the situation is far more complex. It wasclear that the spectrum of minor psychiatric disorderconstitutes a special area of inquiry in its own right, and thatproblems of classification were important in a sphere stilldominated by ill-defined terms.