One hundred and seven patients with neurosurgical disease treated in a combined neurosurgical, neurological, and psychiatric unit within a psychiatric service were reviewed retrospectively. Most patients had acute confusional states or dementia without gross localizing signs and in only three cases did the neurosurgical illness closely resemble a non-organic psychiatric syndrome. The great majority showed abnormalities on physical examination and simple investigations. A past history of alcoholism and/or other psychiatric illness was common. Many apparently had been referred to psychiatric hospitals simply because they presented problems of management. Consequently, the staff of the psychiatric hospitals must be aware of neurosurgical disease and have free access to facilities for its investigation and management. If these requirements are fulfilled, the referral of patients with acute confusional states and dementia to psychiatric hospitals may indeed be preferable to their management in general hospitals, where their disturbed behaviour presents a variety of problems with which these hospitals are not usually equipped to cope.
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