Psychiatrists react to the complexity of human nature in two principal ways; they either take it as justification for their ascientific humanism, or, with unwavering optimism, they accept the challenge and seek scientific explanations. ‘Hormones and behaviour’ has been a favourite hunting ground for such hopefuls, and it is perhaps the sexual part of our natures that we are most ready to attribute to chemistry.

This is an uncertain, neglected and misunderstood corner of organic psychiatry. Calcium disturbances are clinically the concern of physicians interested in bone diseases, in malabsorption or nutritional deficiencies, and opinions vary on whether such illnesses are accompanied by emotional and behavioural disorder: at least psychiatrists are not usually called in. Parathyroid disease is generally granted to have frequent psychiatric accompaniments (e.g. see Granville-Grossman, 1971) but is very rare in the psychiatric clinic, and possibly under-diagnosed there. Laboratory aids tend to be underused or inadequately applied. Total plasma calcium as a screening test cannot be understood without at least a plasma protein measurement as well; but serum phosphate, parathormone and plasma 1, 25-dihydroxycholecalciferol levels, urinary calcium and magnesium, and Ca45, may all have roles in fuller investigation (Nordin, 1976).

The sociological study of institutions has developed considerably in the past two decades. It has moved from the case studies of mental hospitals (e.g. Stanton & Schwartz, 1954; Belknap, 1956) and the graphic, speculative typology of Goffman (1961) to empirically based comparative studies of facilities for both the mentally ill and the mentally handicapped (Hewett et al. 1975; Wing & Brown, 1970; Ullman, 1967; Wing & Hailey, 1972; Morris, 1969; King et al. 1971; Raynes et al. 1977). All these studies have included among their goals the development of our understanding of the structure and functioning of these institutions so as to facilitate the planning, administration and evaluation of better residential services. Further, since the publication of Better Services for the Mentally Handicapped (DHSS, 1971), it is clear that in the United Kingdom the government supports the provision of a continuum of services for mentally handicapped persons. As part of that continuum there is a commitment to provide residential facilities in the community for those who need such services.

This essay traces the shifting perception of the nature and prevalence of suicide in early modern England. Suicide is presented as one form of deviance contemporaries recognized and is used to illuminate the history of mental disorder in its social and intellectual context.

Daft Meg [an idiot and suicide] was a sort of household familiar among us, and there was much like the inner side of wisdom in the pattern of her sayings, many of which are still preserved as proverbs.

John Galt, Annals of the Parish, p. 126.

Inhibition of central dopamine functions appears to be a common basic property of antipsychotic drugs. The mesolimbic and nigrostriatal portions of the dopaminergic system are probably the main targets of these drugs for the mental and the extrapyramidal actions respectively.

Dopaminergic hyperfunction, induced by amphetamines or dopa, may lead to a disturbance mimicking paranoid schizophrenia, lending further support for a key role of dopamine in mental functions.

While a primary disturbance in dopamine function in schizophrenia cannot be ruled out, the intimate relationship between dopaminergic and other neuronal systems must be emphasized. The possible involvement of other amine, aminoacid or peptide transmitters in schizophrenia cannot be disregarded.

Cyclic 3′5′-adenosine monophosphate (c-AMP) was measured in cerebrospinal fluid (CSF) of manic and depressive patients with and without probenecid administration both before and during treatment with various psychotropic drugs. Oral probenecid (100 mg/kg) produced substantial c-AMP accumulations in CSF suggesting a probenecid-sensitive transport mechanism for c-AMP. Baseline and probenecid-induced accumulations of c-AMP were not significantly different in manic and depressed patients, while baseline levels in depressed patients were higher than those in neurological controls. Imipramine, amitriptyline, lithium, tryptophan, and electroconvulsant therapies did not significantly alter levels or accumulations of c-AMP in CSF of depressed patients.

The growth hormone response to insulin induced hypoglycaemia was studied in 7 alcoholic in-patients who had been abstinent for 2–11 days and in 10 normal controls. Blood samples were taken at intervals after the injection of soluble insulin (0·1 U/kg body weight). The growth hormone response was impaired in 4 of the alcoholics and the depression was not related to differences in blood glucose or plasma free fatty acids. The Cortisol response was also impaired in the alcoholics. We conclude that alcoholics observed after alcohol withdrawal may have a depression of hypothalamic/pituitary function.

A study is described of 90 patients receiving lithium prophylactically for recurrent affective disorder. A total of 90 biochemical variables was analysed by correlation matrices. No abnormality in calcium or magnesium metabolism was detected though this may merely be a reflection of the insensitivity of the screening technique used.

On the basis of data derived from a long-term follow-up of 12 cases and a 2-year follow-up of the International Pilot Study of Schizophrenia it is suggested that some patients with remitting schizophrenic illnesses can subsequently present clear-cut affective disorders. The implications of these findings are discussed.

Electro-convulsive treatment (ECT) was therapeutically ineffective in 27 (20 %) of 136 depressed patients. Failure to respond occurred in long-lasting depressions and in patients with a history of long-lasting depressions. In these cases the depression lasted at least 6 months. The hypothesis is proposed that ECT is effective only when given within 6 months of the spontaneous end of the depression. Clinical and nosological implications are discussed.

Using a double-blind placebo-controlled cross-over design, the effect of equine conjugated oestrogens tablets (Premarin®) was studied in 20 women with the climacteric syndrome followed during 15 months. Sixteen women were equally improved on placebo and oestrogen. Only 2 patients had an improved sense of well-being on oestrogen and not on placebo. The psychological diagnosis was unrelated to the subjective response to oestrogen or placebo. Performance in psychological tests administered before and during treatment periods was not changed by oestrogen or placebo.

The level of mental ‘distress’ was assessed for a sample of mothers with pre-school children in Inner London. Fifty-two per cent of mothers had a moderate or severe distress problem in the 12 months prior to interview. Variables correlating with distress were identified and replicated in a second sample. Social class was not found to be related, and the question of the general relationship between social class and distress is considered.

In a large survey of subjects aged between 35 and 64, no difference was detected in the amount of psychiatric morbidity, determined by response to the General Health Questionnaire, between those with hypertension and those with normal pressure. This finding also obtained if only those subjects ignorant of their own blood pressure level were considered for the same comparison.

As a result of administration of a standardized psychiatric interview and a hostility questionnaire to 108 hypertensive and normotensive subjects of a special study, differences in the expression of hostility were demonstrated between the 2 groups. Subjects with hypertension appear to demonstrate more hostility and be less self-critical than a normotensive group. This finding could reflect the effect of recent diagnosis and treatment of hypertension or be associated with the hypertensive state itself.

Twenty-seven symptoms of 859 treated hypertensive patients were evaluated using a self-administered questionnaire and correlated with the depression (DEP), free-floating anxiety (FFA), phobic anxiety (PHO), obsessionality (OBS) and extraversion (HYS) scores of the Middlesex Hospital Questionnaire. The psychological features were associated with 24 of the 27 symptoms, and the extent to 1which these measurements determined the presence of a symptom was calculated. DEP and FFA were correlated with most of the symptoms, PHO with weak limbs, blurred vision, slow walking pace, nocturia and a lessened interest in sex. HYS was positively associated with the frequency of sexual intercourse in men and negatively with complaints of dyspnoea, tingling in the limbs and a slow walking pace. OBS was only associated with diarrhoea.

This paper presents a review of the literature on the effects of maternal narcotic addictions upon the foetus and newborn infant. Six children born to ‘registered’ narcotic addicts were studied, and particular attention was paid to any signs of narcotic withdrawal that might occur after birth. Although all the mothers took heroin or methadone regularly up to the time of delivery, minor physical signs which might have been considered part of the withdrawal syndrome occurred in only one baby. The absence of major withdrawal signs found in this study contrasts with previous findings. The reasons for these differences are discussed, and the implications of these observations for the management of the pregnant narcotic addict and her newborn infant are considered.

The former belief that immigrants always suffer from an excess of mental disorder is no longer valid, and the old rivalry between social selection and social causation hypotheses has lost much of its relevance. The mental health of a migrant group is determined by factors relating to the society of origin, factors relating to the migration itself, and factors operating in the society of resettlement; and all three sets need to be considered if one seeks to reduce or merely to understand the level of mental disorder in any immigrant group. Illustrations from each set of factors are presented, with indications of whether they appear to have general relevance or be related to specific mental disorders.

A pilot study is reported of costs and benefits from behavioural psychotherapy by nurse-therapists for selected neurotic problems. Figures are based on the treatment of 42 neurotics (mainly phobics and obsessive-compulsives) who completed treatment with nurse-therapists in a mean of 9 sessions (16 hours). The year before and after treatment was studied. Apart from significant and lasting reduction in patients' distress, economic benefits to them, their families and the community yielded a worthwhile internal rate of return when benefits from the cohort continue for 3 years, a reasonable assumption on available other evidence. Though untreated phobics did not improve elsewhere over 5 years follow-up, a controlled study would seem desirable.

The paper sets out a method for evaluating changes in psychiatric services in a cost-benefit framework. The first section of the paper analyses some of the problems which arise with those elements which can be measured in monetary terms – the ‘hard’ costs and benefits. The second section looks at a method of presenting the less tangible effects – the ‘soft’ costs and benefits. Finally, it is suggested how these can be brought together to aid rational decision-making.

Several indices of occupational stability are discussed and the importance of controlling for age in assessing occupational stability emphasized. The ability of 6 indices to predict the stable resettlement of psychiatric patients at work after a course of rehabilitation was examined. Though mean job length was a significant predictor, indices based on change of occupation rather than change of job were more successful. Stable resettlement at work was related to how much time people had spent in long jobs but not to how little time they had spent in short jobs. The amount of unemployment during the 2 years before hospital admission predicted return to work immediately after discharge, but did not predict stable resettlement at work.

A psychologist interviewing patients referred to the psychiatric service of a health centre rated twice as much morbidity, measured by total PSE score, as a psychiatrist interviewing equivalent patients. Scores on the self-rated GHQ showed no difference between the 2 groups. It is suggested that such differences could be avoided by giving careful attention to training interviewers.