A survey of 355 college students was carried out to determine the prevalence of the psychiatric disorder bulimia (the binge-eating syndrome). Results of the survey indicate that, within the normal college population, 13% experienced all of the major symptoms of bulimia as outlined in the DSM-III. Within the bulimic population, 87% were females (19% of the female population) and 13% were males (5% of the male population). Although self-induced vomiting may accompany other symptoms of bulimia, the results suggest that self-induced vomiting is not a necessary symptom for diagnosis. A significant relationship between laxative use and self-induced vomiting was detected. These forms of behaviour, termed purging behaviour, occurred in an average of 10% of the students. Individuals who experienced the symptoms of bulimia had a history of being overweight or tended to be in the upper portion of their normal weight range (age, sex, and weight corrected) when compared with those individuals who had not experienced the symptoms of bulimia. No significant weight history differences were detected between vomiters and non-vomiters.

The term ‘pseudo-hallucination’ has received two incompatible definitions. It can refer either to self-recognized hallucinations (exterocepted or interocepted) or to introspected images of great vividness and spontaneity. It is argued that the phenomena to which the two definitions refer might best be distinguished as perceived and imaged pseudo-hallucinations.

LHRH was administered by continuous 4-hour intravenous infusion to 14 anorexia nervosa patients on a refeeding programme. Infusions were repeated in 7 patients following weight gain and in 4 after a course of bromocriptine. Five healthy female volunteers in the early or midfollicular phase of the menstrual cycle served as controls.

The LH response was diminished in patients at 65% standard weight, but was of progressively increasing magnitude in patients at 80% and 95% standard weight. The pattern of LH response to the 4-hour infusion was suggestive of a deficient stimulation by endogenous LHRH in patients at extremely low weights, and of an impaired oestrogen feedback mechanism in patients at intermediate weights. Bromocriptine enhanced the LH response on one occasion in a patient with moderately elevated plasma HPR values, but failed to produce a similar effect when given to 3 patients with normal HPR levels. The mean FSH response did not differ significantly between patients in different weight categories, although those at 65% standard weight had a markedly greater variance of response. Plasma oestradiol values were lower in patients at 65% standard weight than in those at higher weights.

A 2¼-year prospective study of children suffering head injury is described. Three groups of children were studied: (a) 31 children with ‘severe’ head injuries resulting in a post-traumatic amnesia (PTA) of at least 7 days; (b) an individually matched control group of 28 children with hospital treated orthopaedic injuries; and (c) 29 children with ‘mild’ head injuries resulting in a PTA exceeding 1 hour but less than 1 week. Individual psychological testing was carried out as soon as the child recovered from PTA, and then again 4 months, 1 year, and 2¼ years after the injury. A shortened version of the Wechsler Intelligence Scale for Children (WISC), the Neale Analysis of Reading Ability and a battery of tests of specific cognitive functions were employed. The mild head injury group had a mean level of cognitive functioning below the control group, but the lack of any recovery during the follow-up period indicated that the intellectual impairment was not a consequence of the injury. In the severe head injury group, the presence of cognitive recovery and a ‘dose—response’ relationship with the degree of brain injury showed that the intellectual deficits were caused by brain damage. Some degree of cognitive impairment was common following head injuries giving rise to a PTA of at least 2 weeks. Conversely no cognitive sequelae, transient or persistent, could be detected when the PTA was less than 24 hours. The results were less consistent in the 1-day to 2-week PTA range, but the evidence suggested that a broadly defined threshold for impairment operated at about that level of severity of injury. Timed measures of visuo-spatial and visuo-motor skills tended to show more impairment than verbal skills but otherwise there was no suggestion of a specific pattern of cognitive deficit. Recovery was most rapid in the early months after injury, but substantial recovery continued for 1 year with some improvement continuing in the second year in some children, especially those with the most severe injuries. Age, sex and social class showed no significant effects on the course of recovery.

A phenomenological construct of ego-consciousness, subdivided into 5 aspects (vitality, activity, consistency, demarcation, identity) may help for systematic overview of the schizophrenic syndrome. Its construction and empirical evaluation, and the data of 260 schizophrenic probands are presented. The therapeutic implications of the model are elaborated in body-oriented treatment, especially of acute and severely ill cases.

The relationship between left-handedness and birth complications was studied. No evidence of any association was found in either 2 retrospective studies, or 1 large prospective study.

A 2¼-year prospective study of children suffering head injury is described. Three groups of children were studied: (a) 31 children with ‘severe’ head injuries resulting in a post-traumatic amnesia (PTA) of at least 7 days; (b) an individually matched control group of 28 children with hospital-treated orthopaedic injuries; and (c) 29 children with ‘mild’ head injuries resulting in a PTA exceeding 1 hour but less than 1 week. A retrospective assessment of the children's pre-accident behaviour was obtained by parental interview and teacher questionnaire immediately after the accident and before the behavioural sequelae of the injury could be known. Further psychiatric assessments were undertaken 4 months, 1 year and 21 years after the initial injury. The mild head injury group showed a raised level of behavioural disturbance before the accident but no increase thereafter. It was concluded that head injuries resulting in a PTA of less than I week did not appreciably increase the psychiatric risk. By contrast, there was a marked increase in psychiatric disorders following severe head injury. The high rate of new disorders in children with severe head injuries who were without disorder before the accident, together with the finding of a dose–response relationship with the severity of brain injury, indicated a causal relationship. However, the development of psychiatric disorders in children with severe head injuries was also influenced by the children's pre-accident behaviour, their intellectual level, and their psychosocial circumstances. With the exception of social disinhibition and a slight tendency for the disorders to show greater persistence over time, the disorders attributable to head injury showed no specific features.

Bulimia nervosa is a relatively common eating disorder which has a significant physical and psychological morbidity and a poor prognosis. A behavioural approach to its treatment is described. This focuses on increasing control over eating, eliminating food avoidance and changing maladaptive attitudes. Preliminary findings are promising, with improvement appearing to be maintained. Components of the treatment may benefit patients who simply complain of overeating.

Electrodermal activity was measured bilaterally at rest and during stimulation in 22 schizophrenic, 11 depressed and 12 anxiety state patients, and in 32 normal volunteers. No group showed a distinctive pattern of lateral asymmetry. The frequency of spontaneous fluctuations in electrodermal activity was greater in the anxiety state and schizophrenic groups and in those patients who reported auditory hallucinations during recording. Few schizophrenic subjects failed to respond to visual stimulation but a substantial minority failed to habituate. The implications of these findings are discussed.

Schizophrenia and affective disorders selected according to the Feighner criteria can be differentiated on the basis of 40-year outcome. Within schizophrenia the presence of disorganized thoughts at the index admission was associated with poor outcome, whereas better outcome was associated with the presence of delusions or hallucinations. Within the affective disorders, bipolar patients with grandiose delusions or ideas showed a poor outcome; a better outcome was found in unipolar patients with complaints of fatiguability or tiredness at the time of the index admission.

A psychopharmacogenetic strategy was used to investigate a genetic heterogeneity model of schizophrenia. This model consisted of various genetic subtypes represented by patients classified hypothetically according to the types and genealogical (Mendelian) patterns of illnesses in first-degree relatives. The effect of neuroleptics on these subtypes (drug x genetic subtype interactions) were tested for evidence of post-treatment responses which discriminated between them. The findings revealed that schizophrenics who had depressed relatives tended to exhibit (1) depression and more severe pseudoparkinsonism irrespective of types of neuroleptics, and (2) greater remission of paranoid-hostility symptoms when treated with neuroleptics of the aliphatic-piperadine type. Schizophrenics who had schizophrenic relatives failed to show these responses.

Interpretation of these findings emphasized the recognition of these responses as arising from neuroleptic-induced alterations of defective neurologic-neurochemical systems underlying this subtype and as ‘pharmacogenetic criteria’ by which it can be discriminated.

Parents were interviewed at home in a preliminary study of family life variables. Forty- eight had children admitted to an adolescent in-patient unit, 19 of them for school phobia and the remainder because of other psychiatric conditions. Difficulty in obtaining a comparable group from the normal school population resulted in only 12 such families being studied in addition. The psychiatric cases were reliably separated into school phobic and other problems. Practically all the school phobics had neurotic disorders. Contact of parents with relatives and friends, their leisure activities outside the home, their patterns of work and their management of domestic affairs, were looked at. It was thought that these aspects of family functioning might be distinctive where there was a school phobic youngster and that an abnormal pattern of family life might predispose a child to this disorder. In fact, no evidence emerged to suggest that parents of school phobic adolescents participate in, or make decisions about, family life activities in any way different from parents of other psychiatric cases or normal controls.

Seventy-three patients who had been continuously receiving lithium carbonate for 6 months or more had their thyroid function evaluated clinically and biochemically. Goitre was found in 37 %, exophthalmos in 23 %, positive thyroid auto-antibodies in 24 % and abnormal TRH tests in 49 %. It would appear that thyroid failure due to lithium is usually dependent on antibody mediated damage. It is unlikely that lithium has a direct effect on the hypothalamic–pituitary axis.

Various studies have shown: (i) increased rates of psychoses in immigrants to Britain, and a particularly high rate of schizophrenia in the West Indian- and West African-born; and (ii) a greater proportion of atypical psychoses in immigrants. A retrospective study of psychotic inpatients from a London psychiatric unit demonstrated increased rates of schizophrenia in patients from the Caribbean and West Africa. These patients included a high proportion of those with paranoid and religious phenomenology, those with frequent changes of diagnosis, formal admissions, and married women. The West Indian-born had been in Britain for nearly 10 years before first seeing a psychiatrist and, if they had an illness with religious symptomatology, were likely to have been in hospital for only 3 weeks. Rates of schizophrenia without paranoid phenomenology were similar in each ethnic group. It is suggested that the increase in the diagnosis of schizophrenia in the West Indian- born, and possibly in the West African-born, may be due in part to the occurrence of acute psychotic reactions which are diagnosed as schizophrenia.

Forty-eight newly admitted schizophrenic patients were treated with a fixed, conservative (6·6 mg/kg) dose of chlorpromazine (CPZ) for 28 days. CPZ plasma levels were measured by a gas chromatography mass spectrometry method (GCMS) using 2H6-chlorpromazine as an internal standard. At the end of the fixed-dose period, ‘responders’ had the same plasma levels as ‘non-responders’, suggesting that lack of response is primarily a matter of the illness' sensitivity to CPZ, not to a plasma level below some therapeutic window. After the fixed-dose period, the dosage of CPZ was increased in the ‘non-responders’ by physician's choice. Improvement occurred over a wide range of 10–225 picomoles (3–72 ng)/ml. Above 300 picomoles (95 ng/ml) 4 inaccessible patients eventually became much worse, suggesting psychotoxicity. It is in the inaccessible patient whose illness is only minimally, or not at all, sensitive to CPZ that a plasma level might be especially useful.

Interpretation of plasma levels is complicated by the speed of response: some initial non-responders improved by the 56th day of treatment on very conservative plasma levels.

The Eating Attitudes Test (Garner & Garfinkel, 1979) was administered to 578 students (446 females and 132 males) at a College of Technology and to 14 ‘control’ subjects fulfilling diagnostic criteria for anorexia nervosa. Although no male students scored highly, a total of 28 female students (6·3% of the female student sample) scored in the ‘anorexic’ range. These ‘high scorers’, together with a random control group of 28 ‘non-high scorers’, were subsequently Interviewed. Interview revealed that the symptoms of anorexia nervosa were common in the high scoring group but virtually absent in the student control group. It is concluded that a substantial proportion of post-pubertal females (approximately 5%) develop a subclinical form of anorexia nervosa. The implications of these findings are discussed in relation to the aetiology, prevention and treatment of disturbances in eating behaviour.

An epidemic of suicide by burning in England and Wales occurred during the one-year period October 1978 to October 1979, following a widely publicized political suicide. For the 82 cases, death certificates were obtained and coroners' inquest reports sought. The victims were predominantly young single men or older married women; both groups had strong psychiatric histories; and there were no suicides which had political overtones, apart from the index case. Compared with suicides by this method in the past, a higher proportion of victims were born in the UK. It is proposed that a code of practice for the reporting of suicides by the media is required.

Bilateral electrodermal orienting responses were measured to repeated auditory stimuli in schizophrenic patients and controls. In 3 studies phasic activity to moderate intensity sounds of patients on no drugs or phenothiazines was predominantly hyper- or hypo-responsive. Controls showed moderate or slow habituation. Propranolol was found to facilitate habituation in slow habituators and to reinstate responses in half of non-responders, especially when given as the sole drug. The effects seldom had a counterpart in changes in non-specific responses or levels of skin conductance. Modulatory influences on stimulus and response processing and on lateral asymmetries in responses may underlie propranolol's efficacy in treating schizophrenia.

In a cohort of patients with an operationally confirmed diagnosis of mania, half of the patients had received a previous diagnosis of schizophrenia, and over one third of the patients had received a diagnosis of personality disorder. Retrospective analysis of case-notes, using operational criteria based on DSM-III, found that manic-depressive illness was more likely to have been the correct previous diagnosis.

A prospective study of patients with religious delusions identified 24 West Indian and West African patients. Those who had none of Schneider's first-rank symptoms of schizophrenia (principally West Indians) differed from those who did by virtue of early religious commitment, life-long religious experiences, an acute admission precipitated by social events, a greater chance of having their diagnosis changed, less than 10 different PSE syndromes, the absence of ‘twentieth-century’ delusions, and the presentation of malevolent witchcraft as the sole explanation of the episode. It is suggested that this group can usefully be considered as demonstrating an acute psychotic reaction of the type previously described in Africa and the Caribbean.