Plasma free tryptophan is significantly decreased in monopolar, depressed patients. No evidence was found to suggest that poor nutritional history prior to hospital admission was responsible for these low levels. Factors known to influence tryptophan—albumin binding in plasma, e.g. concentration of plasma proteins, albumin and non-esterified fatty acids, did not account for the low levels of free tryptophan in depressed patients. A significant decrease in plasma free tryptophan levels was found in perimenopausal but not in pre- or post-menopausal female controls. This mirrors the decrease in circulating oestrogens. Although exogenously administered oestrogens do not have any therapeutic efficacy in relieving mild residual depressive symptoms of lithium treated patients, they increased the levels of plasma free tryptophan. Clofibrate also displaces tryptophan from plasma protein binding sites in both depressed patients and controls. Utilization of the increased levels of plasma free tryptophan is reduced in depressed patients. A situation therefore exists in depressed patients where the plasma free tryptophan is not only reduced but also leaves the plasma less readily than in control subjects.

Very little is known about psychiatric disorders in severely and profoundly retarded adults. We have investigated these disorders by systematically recording and collecting data about the behaviour of 100 severely and profoundly retarded hospitalized adults and subjecting the data thus derived to cluster analysis. Eight clusters were isolated. The clinical psychiatric significance of these clusters is discussed and their relationship to cause of retardation, duration of stay in hospital and visiting is considered. A diagnostic framework for psychiatric disorder in severely and profoundly retarded adults is put forward and some possible treatment approaches are suggested.

A standardized social interview, designed to assess social maladjustment and dysfunction is described. The interview is composed of items grouped under the 3 headings of Material conditions, Social management and Satisfaction. Ratings are made on a 4-point scale by interviewers standardized in its use. The interview, which takes approximately 45 minutes to administer, covers housing, finance, occupation, social and leisure activities, and relationships with significant individuals in the subject's life. The inter-rater reliability is assessed and principal component analyses performed, and the results of these are provided and discussed. Various methods of scoring are examined and the use of the schedule in a number of studies in the setting of general practice is described.

In a 5-year follow-up of 32 patients identified during a survey of a Dutch village in 1969, approximately two-thirds were found to have recovered. This result was reflected in the scores on a self-reporting questionnaire. A control group showed little change over those years. The persistence of psychiatric problems was related to life experience, as measured by a life-event interview.

The Psychosocial Adjustment to Illness Scale (PAIS) was administered to 37 Hodgkin's disease patients and 38 parents of children with Hodgkin's disease or solid tumour, and the scores were analysed for inter-rater reliability as well as construct and criterion validity. A significant inter-rater reliability coefficient was obtained for the total scale score, and also for 6 of the 7 subscale scores. The 7 subscale scores were shown to be relatively independent of each other, with 5 contributing strongly to the total score. Subscales analysed for criterion validity were shown to correlate significantly with independent assessments of their domains of adjustment. Results indicate that the PAIS can be administered by a diverse group of interviewers with an acceptable degree of reliability and with initial confidence in its validity.

Suicide rates in towns with a Samaritan branch were compared with rates in matched control towns without a branch. Four methods of choosing controls are described, all of which have advantages over those used by Bagley (1968). No statistically significant differences between Samaritan and control towns were found. The scientific case for the effectiveness of the Samaritans in reducing the suicide rate is therefore seriously weakened.

This paper discusses the magnitude of the effect of life events in the causation of psychiatric illness. It is argued that an established epidemiological concept, relative risk, provides a useful measure of association which can be approximately adapted for retrospective controlled studies. Examination of studies employing general population controls consistently indicates effects of some importance, with risks of illness increased by factors of between 2 and 7 in the 6 months after an event. Risks are greater for the more stressful types of events, greater for depression and neuroses than schizophrenia, and even greater for suicide attempts. However, similar events occur commonly and a large proportion of event occurrences are not followed by illness. Events must interact with a wide variety of background factors, and the appropriate model is one of multifactorial causation.

Evidence from a controlled, comparative trial indicates that oral pimozide is clinically at least as effective as depot injections of fluphenazine decanoate in the continuation therapy of a group of schizophrenic patients discharged from hospital. The administration of pimozide was associated with fewer unwanted effects. The implications of the findings are discussed.

The records of all suicides and of all open verdicts in Lusaka (Zambia) over a 5-year period (1967–1971) were studied. The following suicide rates (per 100000 of the population per annum) were found: 7·4 for all races; 11·3 for men of all races; 3·0 for women of all races; 6·9 for all African residents; 11·2 for African males; 2·2 for African females; 12·8 for all Africans above the age of 14 years; 20·9 for all European residents; 20·7 for all European males; 21·0 for all European females. The male: female ratio among the Africans was 5:1. There was a tendency for the suicide rate among the Africans to rise with age. Differences in suicide rates between African and European residents were found not to be statistically significant. Though hanging was by far the most commonly used method of suicide by Africans, Europeans and ‘doubtful suicides’ among Africans preferred other methods to a statistically significant degree. It is suggested that the role of other methods in African suicides may well have been underestimated in the past. No definite seasonal variation in suicide rates was found. Domestic quarrels, mental illness and physical diseases would appear to be some of the important precipitating factors of suicide in Lusaka. It is also suggested that the question of whether or not suicide is rare in Africans cannot be answered until such time as when reliable figures are available in Africa.

The death risk for psychiatric patients has decreased over the last 30 years but still remains higher than that of the general population. The death risk for patients with a diagnosis of neurosis is higher than that for the general population. Previous studies are enlisted to investigate this mortality for socio-economic characteristics, alcohol and drug abuse, psychopathy and accident proneness. Possible psychosomatic aetiology of disease and subsequent death is examined. Psychological theories for premature death are discussed and some recommendations made for future areas of enquiry.

Three hundred and sixty depressed in-patients initialy treated with imipramine, chlorpromazine or a placebo were re-evaluated a year later. Patients showing the poorest adjustment at one year were those who failed to show a good initial response to treatment and those who responded positively to a placebo.

Results are compared in studies of 4 male cohorts – 1 all white, 1 all black, and 2 racially representative of the population – growing up in different eras, followed past varying portions of their adult lives, living in different parts of the US. Despite sample differences and differences in sources of information and in the variables used to measure both childhood predictors and adult outcomes, some striking replications appear with respect to childhood predictors of adult antisocial behaviour. All types of antisocial behaviour in childhood predict a high level of antisocial behaviour in adulthood and each kind of adult antisocial behaviour is predicted by the number of childhood antisocial behaviours, indicating that adult and childhood antisocial behaviour both form syndromes and that these syndromes are closely interconnected. Also confirmed across studies are: (1) adult antisocial behaviour virtually requires childhood antisocial behaviour; (2) most antisocial children do not become antisocial adults; (3) the variety of antisocial behaviour in childhood is a better predictor of adult antisocial behaviour than is any particular behaviour; (4) adult antisocial behaviour is better predicted by childhood behaviour than by family background or social class of rearing; (5) social class makes little contribution to the prediction of serious adult antisocial behaviour.

A blind social assessment at home was carried out twice during a year's follow-up of 41 patients on continuation therapy, 21 randomly allocated to pimozide tablets and 20 to fluphenazine decanoate injections. Patients on pimozide were significantly more favourably rated on aspects of sociability, use of leisure, warmth of personal relationships, household tasks and child-rearing. The mode of production of this result is discussed.

Evoked potentials and reaction times were obtained from chronic schizophrenics and normal controls to light and sound stimuli presented in random order. In the ‘ certain’ condition subjects were told what the next stimulus would be, in the ‘uncertain’ condition they were asked to guess. Amplitudes were usually larger for normals than for schizophrenics, for ‘uncertain’ than for ‘certain’ conditions, and in cross- than in ipsimodal stimulus-sequences. The effect of certainty was stronger in normals across 4 leads; so was the effect of modality shift at vertex. While these findings replicate earlier results from acute schizophrenics, no condition x group interactions could be found in the reaction time measures.

Two additional results were interpreted as showing basically different attitudes with respect to the predictability of events: (1) there was a slow positivity between the verbal information and the following stimuli which was largest for schizophrenics in the conditions of certainty; (2) while normals showed long-term habituation only in N1- but not in P3-amplitudes, the reverse was true for schizophrenics.

Forty-two couples with marital problems were randomly allocated to conjoint therapy of (i) a directive, (ii) an interpretative or (iii) a supportive (control) type. Self and independent assessment at the end of treatment showed the directive significantly superior to the control procedure on several measures. This superiority was maintained to 18 months' follow-up, when the interpretative procedure also showed some superiority over the control.

Monthly hospital admission rates (HA) for mania were classified by sex, type of admission (first, or re-admission) and by country (England and Wales or Scotland). Of the 8 classes thus created, all but one showed a statistically significant annual cycle with a peak in Summer and trough in Winter. There was no significant difference in phase or amplitude between male and female cycles. A linear increase in yearly re-admission rates was found during the 8 years of the English and the 11 years of the Scottish data.

Current month's mean daily temperature (lag0) and last month's (lag1) mean day-length and mean daily hours of sunshine correlated better with admission rate than did the values for other months. In a multiple regression analysis temperature made the other 2 climatic variables redundant in accounting for variation in HA.

The responses of 6 representative physiological parameters frequently assumed to be measures of anxiety along with a set of 4 psychological tests for measuring anxiety were obtained under naturalistic conditions from 25 patients hospitalized with a first myocardial infarction. A canonical correlational analysis failed to show any relationship between anxiety as assessed by the Taylor Manifest Anxiety Scale, Mood Adjective Check List, State-Trait Anxiety Inventory and Multiple Affect Adjective Check List psychological tests, and anxiety as assessed by the physiological indices of heart rate, systolic and diastolic blood pressures, epinephrine, norepinephrine and VMA. The intercorrelation matrix revealed a significant positive pattern of relationships among all 4 psychological tests, a non-significant, positive pattern of relationships among the physiological indices, and a non-significant, negative pattern of relationships between the psychological and physiological measures. The absence of mood-specific physiological measures for anxiety, as measured by the psychological tests, supports previous theory and investigation and points to the inadvisability of assuming that studies on anxiety that use diverse physiological and psychological measures yield results that may be compared as though they were assessing a common mood.

By means of the Self-Administered Dependency Questionnaire (SADQ), 4 types of dependency on mother were measured in 65 children with epilepsy attending ordinary school, subgrouped according to sex, level of schooling, electrographic type of epilepsy, and drug treatment. The various dependency scores of each subgroup were compared with the appropriate norms available for the SADQ. Compared with normal boys, epileptic boys of primary school age (N = 16) were generally found to be more in need of close physical emotional contact with their mother and her physical proximity when away from home, although they were less ready to talk to her about their practical problems and ask for her help. The needs of epileptic boys of secondary-school age (N = 18) were expressed more in terms of their mother's help with practical matters at home. In contrast, no significant differences were apparent between epileptic and normal girls at either level of schooling. In comparisons between epileptic children who consistently produced only generalized seizure activity in their EEG (N = 31), a right temporal spike discharge (N = 16) or a similar discharge on the left (N = 18), both boys and girls with a left temporal spike discharge tended to show significantly higher need for close physical emotional contact with their mother than children in the other electrographic groups. No clear relationship was seen between dependency scores and type of anti-epileptic drug treatment.

Eighty-nine new referral hypertensive out-patients and 46 new referral non-hypertensive chronically physically ill out-patients completed a mood rating scale at regular intervals for one year. The results showed a high prevalence of depression in both groups of patients, with no preponderance in the hypertensive group. Hypertensive patients with psychiatric histories had a higher prevalence of depression than the comparison patients. This was accounted for by a significant number of depressions occurring in methyl dopa treated patients with psychiatric histories.

Seventy-three patients with the features of ‘cycloid psychosis’, adopted from Perris and Leonhard, were identified from case records. Information concerning background, presenting illness and follow-up was compared with that from the case-records of patients with schizophrenic, affective and schizoaffective psychoses. The characteristic features of ‘cycloid psychosis’ were a female predominance and a remittent course. The ‘cycloid’ group resembled the conventional groups in some respects, but differences from schizophrenic, affective and, to a lesser extent, schizoaffective groups were also striking. The factors which might account for the apparent independence of the ‘cycloid’ group from other diagnostic categories are discussed.