The findings in this paper are based on 13 patients (12 female and 1 male) under my personal care who all satisfied the criteria for the diagnosis of anorexia nervosa (Russell, 1970). In addition, they had persistently made themselves vomit after most meals, over the course of several years (mean of 5.4 years). There were also episodes of over-eating that culminated in vomiting. The vomiting was done in private and achieved by stimulating the throat with fingers or a toothbrush, drinking large amounts of fluids or bending over, or a combination of these devices.

When confronted with patients who indulge in frequent self-induced vomiting one has to ask oneself the question ‘why do they do it?’ At the simplest level the answer to this question is that there are clear advantages to the patient from this behaviour. Patients can indulge their cravings for food to excess while at the same time avoiding the consequences in terms of weight gain. They can literally ‘have their cake and eat it’. The first therapeutic requirement is therefore to convince the patient that the disadvantages of self-induced vomiting, in terms of effects on physical health, far outweigh these benefits. Let us assume that we have been successful in this respect; the next step is to undertake a behavioural analysis.

The tendency of anorexic patients to overestimate their own body size was one element of Bruch's (1962) concept of body image disorder. The first experimental validation of this tendency was reported by Slade and Russell (1973), who also demonstrated that overestimation was directly related to a poor prognosis and that patients tended to become more accurate with therapeutically induced weight gain.

Consultation-liaison psychiatry has emerged as a significant area of special interest within clinical psychiatry in recent years. It seeks to enhance the quality of psycho-social care of medically ill patients and of their psychological reactions to illness; to provide effective consultations not only with regard to patient management, but also to the complex problems arising where serious medical and psychiatric illness overlap, and to deal with the personal difficulties arising in members of the clinical team caring for the patient. It has an essential contribution to make to the actual practice of holistic, comprehensive health care; rather than just to the airy rhetoric by which whole-person medicine exists in the medical school's prospectus and objectives but not in its wards. We do not teach mere vapid sympathy, but competent psycho-physiological understanding of the patient, and sound communication skills.

Studies of West Indian and West African immigrants have consistently shown high rates of diagnosed schizophrenia, although they differ in the extent to which the illness is seen as atypical. A retrospective examination of hospital notes at an East London Psychiatric Unit showed that although total admissions were similar in different ethnic groups there was an excess of schizophrenia in Caribbean and West African migrants similar to that found previously. These patients also showed an increase in two pathoplastic features, religious and paranoid flavour and an increased proportion of women, formal admissions and short admissions.

The aetiology of puerperal psychosis remains controversial. Because of the obvious psychological and emotional implications of childbirth, there is a school of thought which regards it as largely psychogenic and therefore relies heavily on a psychotherapeutic approach.

The case notes of 85 patients admitted to the Mother and Baby Unit and 50 non-puerperal women of the same age group, admitted to Withington Hospital, Manchester, were studied. All case notes were abstracted and all information about their mental state, stripped of contextual clues, was noted. The abstracts were reviewed by two social workers and two psychiatrists, all of whom were ignorant as to the number of patients with puerperal psychosis.

Biological sex, gender identity and gender role are concordant in most individuals. Transsexuals seek reassignment of gender role and anatomical sex to fit their gender identity. Thirteen males and three female transsexuals have been assessed.

A sample of borstal boys was selected (56). All had an assessment of mental state and ratings of sociopathy and aggressiveness performed, using structured interview techniques. A group of RAMC apprentices matched for age, sex and social class, was also examined (56). Eight-channel bipolar scalp EEG recordings were taken, 4 channels (T4–T6, P4–O2, T3–T5, P3–O1) being recorded on analogue tape. The tape-recorded signals were filtered off line through a low pass filter, multiplexed and digitized on to magnetic tape. Power spectral analysis was carried out on this data, using the University of London CDC 60 600 computer. Three 30-second epochs were analysed: eyes closed, eyes open, and eyes closed. No significant EEG differences were found between the borstal boys and the control sample. Neither visual inspection nor power spectral analysis revealed any EEG differences between the borstal boys and controls. Correlation coefficients between the power at each frequency from all four channels, the violence and sociopathy ratings and the time spent in institutional care in months for each boy were computed. These showed that violence contributes not more than 1 per cent and sociopathy not more than 5 per cent to the variance of the EEG power. Duration of stay in the institution accounted for as much as 20 per cent of the variance of the EEG power with significant correlations at 7 Hz (positive) and 11 Hz (negative). Duration of stay is thus a variable that must be controlled for during the investigation of subjects in penal institutions and long-stay hospitals.

This paper examined some social and clinical characteristics of a group of formally admitted patients. Factors of a more long-standing nature preceding the admission were particularly emphasized. The study describes a group of 80 consecutive formal admissions from a London borough and compares them with a random sample of 80 informal admissions. The borough has many characteristics associated with an inner city area, e.g. a high incidence of people living alone, foreign born, single and the elderly.

Examination of the existing literature on long-stay patients reveals two interesting parallel trends: an emphasis on descriptive studies characteristic of British literature and an equally singular emphasis on prediction of outcome in studies from the USA. No attempt has yet been made to combine the two methods. The present investigation represents such an attempt.

The Royal College of Nursing recently published a book in their research series entitled Nursing in Behavioural Psychotherapy (Marks et al., 1977) which reviewed developments in the field. Operational research into nurse-therapy began in 1972 at the Maudsley Hospital. Out of this a national course was formalized in 1975 by the Joint Board of Clinical Nursing Studies for England and Wales (Course No. 650). Although the formal course lasts 18 months, it is now possible to shorten the training period to one year, followed by six months of lightly supervised practice working in settings away from the training centre. Currently there are two recognized training centres, at the Bethlem/Maudsley and Graylingwell Hospitals, and moves are afoot to start a third programme elsewhere.