Psychiatric referral of patients in a venereal diseases clinic.

A NEW department for patients with venereal and sexually-transmitted diseases, James Pringle House, was opened in 1965 at the Middlesex Hospital, and psychiatric investigation has been regularly available since December, 1967.This follows the general policy at the Middlesex, where a member of the department of psychiatry is attached to each department of the general hospital; and accords with the specific recommendations (Pahmer, 1949; Mayer-Gross, Slater, and Roth, 1960) that venereology clinics in particular need to have a psychiatrist available within the same premises.The criteria for referral were not specified and are clearly as various as the psychiatric attitudes of the many doctors working in the clinic.This report is a first impression gained under the conditions out- lined, and is by no means a comprehensive survey of the extent of psychiatric disturbance in patients attending this clinic.Several earlier studies of psychiatric disturbance in patients attending venereology clinics have been concerned with the problem of morbid fears of venereal disease.A study of patients presenting with overt syphilophobia (Macalpine, 1957) was prompted by the finding that half of the patients in a dermatology department with intractable pruritus ani feared they had syphilis.She found syphilophobia to be a symptom accompanying or preceding all stages and categories of mental illness; all her patients had previously attended other venereology clinics and had an average of six negative results to serum tests for syphilis.The report of Gibbens and Silberman (1960) arose from an inquiry, undertaken before the passage of the Street Offences Act, into the nature of the demand for prostitution.Of 230 patients from a venereology clinic who were interviewed, 30 per cent.did not have venereal disease but feared they had.Kite and Grimble (1963) were concerned with the extent to which fear of venereal disease may be