The "aging" of the world population is by now a well-recognized phenomenon. It has become a matter of concern to the social planner and deliverer of services, as weil as to the clinician. On aper capita basis, the aged-that is those 65 and older-appear in outpatient health care facilities at a rate wh ich is approximately fifty percent greater than their adult peers, stay about three times as long in general medical and surgical facilities, and represent more than 90 percent of the long-term-care beds in the United States. In addition, at a time when they represented approximately 10 percent of the total population, the aged were the recipients of 25 percent of all prescriptions for medication. Thus, an understanding of the drug use consequences, misuse and abuse of drugs among older persons, has become a salient issue for the scientist, clinical physician, and other health care professionals. The aged are a group at heightened risk for a number of disorders and often present with clinical problems not usually encountered in an aging population. Many such problems are the direct consequence of multiple, concurrent, and complicating disorders; drug/drug interactions, com pliance with physician prescription, the use of concurrent non-prescribed substances such as alcohol or over-the-counter medication, and a variety of other behaviors. There is also a growing interest in the well recognized, but poorly understood, pattern of organic changes which occur in later maturity."

This volume represents the proceedings of a Symposium on Psychopharmacology and the Aging Patient, held at Duke University, May 29-31, 1972. The conference was jointly sponsored by the Center for the Study of Aging and Human Development and the Department of Psychiatry at Duke. This Symposium was the first in a series of conferences which will be devoted variously to preclinical and clinical pharmacology of the different groups of psychotropic drugs, especially as they relate to the problems of the elderly patient and to the special considerations that must be given in theory and in practice to changes brought about by the process of aging. The idea behind this particular symposium was to bring basic and clinical scientists together with practicing clinicians and other mental health professionals for an exchange of ideas and interests through formal didactic and informal small sessions. The major interest, of course, was to disseminate current information on the clinical use and indication for psychoactive agents, particularly as they related to the elderly patient. Recognition and management of psychiatric syndromes of the elderly were included as they were pertinent to psychopharmacology of aging to indicate the direction of ongoing work and to stimulate further research in this area. The editors wish to gratefully acknowledge the generous financial support xiii xiv Foreword of the Symposium granted by the following pharmaceutical firms: Smith-Kline-French Laboratories Pfizer Laboratories and Abbott Laboratories Burroughs-Wellcome Company CIBA - Geigy Corporation Lakeside Laboratories McNeil Laboratories, Inc.

This volume offers a critical evaluation of seven major paradigms in psychiatry that have made significant contributions to our current under standing of human behavior and psychiatric disorder. It was stimulated by a meeting held in November, 1978. We met at Salishan Lodge, Oregon, to discuss some of the theoretical orientations in behavioral sciences which serve as a base for contemporary psychopathology. Each major paradigm is represented by both an advocate as well as a critic. Advocates of a position had each agreed to be criticized by an individual who may not have been particularly sympathetic to the paradigm being presented. Furthermore, the entire group of participants had ample time for discussion with both the proponent and the critic. The papers in this volume were completed following that meeting, and each author has had the benefit of the criticism and discussion. The editors believe that the unusual array of talented scientists and clinicians have made an important contribution to clinical science by elaborating their positions in the face of open discussion and are proud to be part of this body of work. We wish to thank each of the participants for helping to sustain a very high level of critical scholarly discourse, which provided the right ethos for probing some of the major conceptual models of psychopathology."