First admission rates have been determined for immigrants living in Manchester. They show that immigrants as a whole had about twice the rate of British-born subjects, but that various subgroups had rates still higher, including those aged 35–44 and Asian women. According to hospital diagnoses the psychiatric conditions responsible for these increased rates are schizophrenia (in all groups) and neuroses and personality disorders (in the Asians). A case note study of the psychopathology showed, however, that the most characteristic symptoms of schizophrenia were not more common in the immigrants. It is concluded that most of the immigrants are suffering from paranoid psychoses, not schizophrenia.

An epidemiological study of first admission to psychiatric hospitals in Bradford revealed that foreign-born people had substantially higher illness rates than native born. Comparing the major World War II refugee groups it was found that morbidity was higher among Poles than Ukrainians. It is suggested that the difference can be partly explained by the lower social cohesion of the former. The resulting marginal identity is insufficient protection against the normal crises and losses of later life.

Clinical experience with women in strictly controlled socially inferior positions in Saudi Arabia illustrates how somatic complaints can express emotional problems which have no other outlets. The women are passive and for therapy to succeed an alliance with a male relative is necessary. Measures to combat passivity can be of great benefit.

To test the possibility that the antidepressant action of ECT is due to an enhanced responsiveness to the stimulation of monoamine receptors, we have measured pituitary hormone responses to test doses of clonidine and methylamphetamine in depressed patients before and after a course of ECT.

There was no enhancement of the growth hormone response to either drug following a course of ECT. Cortisol responses to methylamphetamine were enhanced, but probably this was secondary to the partial or complete recovery of the patients. Further neuroendocrine studies of the mechanism of action of ECT in man are needed.

This retrospective study, based on 18 case reports, describes an organic affective syndrome, manic type, occurring shortly after the initiation of thyroid replacement in hypothyroid patients. The symptomatology and homogeneity of the syndrome offers insight into the relationship between thyroid activity and affective disturbance. The patients experiencing mania showed concurrent psychopathology at the time of replacement therapy, frequently had a past history of personal or familial psychiatric disorder and were given dosages in the high range of normal. The potential morbidity of the manic state was considerable. These findings suggest that a group of hypothyroid patients at risk can be identified. In such a group, lower initial dosages and gradual increases in dosage may be indicated.

Plasma growth hormone (GH) release after TRH injection was investigated in 27 unipolar and 23 bipolar depressive women, and in 39 normal female controls matched for age, sex and menopausal status. Peaks of GH secretion after TRH were observed in some depressive patients as well as in some normal controls, but there were no significant differences in GH response after TRH administration between patients and controls. The implications of these findings are discussed in reference to such factors as non-specific stress responses and abnormal neuroendocrine circadian rhythms in affectively ill patients.

Under double blind conditions 55 young, bottle feeding, multiparous women received L-tryptophan 3 g daily or placebo for ten days after delivery, and were also assessed daily for psychiatric symptoms. This treatment did not reduce ‘maternity blues', but the mothers' blues scores correlated significantly with the scores for anxiety, depression and hysteria on the Middlesex Hospital Questionnaire given in the eighth month of pregnancy.

The excretion of N,N,-dimethlytryptamine (DMT) has been measured in longitudinal studies of five patients with schizophrenic illnesses and in four patients with rapidly or slowly cycling manic-depressive illness. The excretion of DMT was frequently raised in patients when they were psychotic but was usually normal when they had recovered. However, rapid changes in the severity of illness or sudden switches from one mood state to another were not accompanied by changes in the excretion of DMT. These findings contrast with the immediate hallucinogenic effects of an injection of DMT, and suggest that the extracerebral production of DMT (as measured by its urinary excretion) does not provoke the experience of hallucinations in psychotic patients.

Sodium valproate given in doses of 750–3000 mg daily to eight schizophrenic patients produced a qualitatively similar increase in symptoms in five. CSF showed no significant change in γ-aminobutyric acid or methoxy hydroxyphenyl glycol, but homovanillic acid increased non-significantly in five patients.

The mental states of 23 epileptic psychotic patients and 10 patients with process schizophrenia were compared, using the Present State Examination. The epileptics displayed marked heterogeneity of psychiatric diagnoses. Disturbances of affect underlying the psychosis or presenting as manic-depressive psychosis were frequent and independent of the type of epilepsy. Schizophrenic psychosis, classified with psychopathological criteria similar to those used in the non-epileptic schizophrenic group, was significantly associated with temporal lobe epilepsy. Psychoses other than schizophrenia, however, were present in 5 out of 16 patients with temporal lobe epilepsy. These results support a relationship between schizophrenic symptoms and temporal lobe pathology and emphasize the need to use reproducible methods of diagnosis in psychiatric research.

One hundred and two mentally handicapped and severely mentally handicapped patients with behaviour disorders and superadded mental illnesses which, in most cases, had not responded adequately to oral medication, entered a 12-week study of fluphenazine decanoate depot injections. Some of the patients had the additional complications of epilepsy, organic brain damage, and physical handicap. Highly significant overall improvements occurred, irrespective of such factors as the patient's age, sex, degree of mental handicap, or co-existence of epilepsy, or brain damage. Hyperpyrexia was not encountered. Extrapyramidal disturbance in 22 of the patients, were mostly well controlled by antiparkinson medication; eight of the 12 patients with pre-trial extrapyramidal abnormalities lost these during the study. Fluphenazine decanoate injections proved a reliable drug-delivery system, which may improve difficult behaviours and enable the mentally handicapped patient to be more receptive to behaviour-shaping exercises, aimed at improving long-term personality adjustment.

During recent years there has been considerable controversy concerning the classification of depressive disorders. Investigators disagree as to whether depressive disorders are a single phenomenon with varying degrees of severity or are a group of two or more discrete illnesses with differing courses, prognoses, responses to treatment, familial backgrounds, aetiologies, and clinical pictures (Eysenck, 1970; Kendell, 1976; Foulds and Bedford, 1976; Andreasen and Winokur, 1979). They also disagree about the boundaries between depressive disorders and anxiety disorders, schizophrenia, personality disorders, and normality (Roth et al, 1972; Kay et al, 1976; Kendell and Gourlay, 1970a and b; Tsuang et al, 1976). There is no consensus as to what constitutes adequate validation of a nosological class; a variety of independent validators have been proposed, including genetic factors, outcome, responses to treatment, and neurochemical or neurophysiological markers (Guze, 1978; Blashfield and Draguns, 1976; Kupfer et al, 1975; Reider and Gershon, 1978).

Marital interaction appears to be relevant to alcoholism. This study compares two groups of couples, each presenting with sexual dysfunction. One group has an alcoholic member in each couple, one group does not. Data are presented suggesting that alcoholic marriages can be distinguished, in a clinically useful way, from other troubled marriages. Alcoholic husbands feel submissive, but are not being forced by their wives to be so. This suggests a therapeutic approach different from the one that would be taken if the wives were actually dominating.

The comparative value of possible therapeutic factors in group psychotherapy was studied by submitting questionnaires regularly to patients and therapists of six long-term out-patient groups. Both patients and therapists attached most importance to self-understanding, self-disclosure and learning from interpersonal actions. They diverged, however, in their overall perception of which factors were important in therapy.

Two groups (N = 26) of patients with chronic anxiety were compared in their response to different forms of relaxation therapy. One group received 16 sessions of frontalis EMG and the other 16 sessions of progressive relaxation. Although EMG feedback was much superior in reducing frontalis EMG activity this treatment was no more effective than progressive relaxation in reducing symptoms of anxiety. Few patients in each group showed more than marginal improvement.

Two pairs of monozygotic twins concordant for obsessive-compulsive neurosis are described. In each the proband and co-twin developed their symptoms independently and without prior knowledge of the other's illness. Despite this there was a marked similarity of symptoms within each pair. The existence of these and other pairs reported elsewhere, strongly suggests that familial and possibly genetic factors contribute to the aetiology of the disorder.