The content analysis was made of special thirty minute discussions between each of 30 acute male schizophrenics and their parents to determine features of parental personality. All patients were discharged, but after 2 years 13 of them had been readmitted. Compared with those not readmitted their fathers expressed more outward-directed hostility and hostility projected on to others, and their mothers expressed more inward-directed hostility as well as guilt anxiety and shame anxiety. Both parents were emotionally more unstable during the course of the discussion. The emotional interaction between mothers and sons was of symmetrical type (whereas it was complementary between mothers and sons who had not been readmitted).

The inter-electrode resistance during ECT is shown to be very variable, a finding which invalidates the measurement of shocks in joules. With square wave pulses of selected current value the threshold for convulsion may be below 100 milliamperes or above 2,000 milliamperes. It is advisable to measure the current value during millisecond pulses with relatively long intervals between.

EEG monitored ECT was administered to 20 patients, 12 females and 8 males. One hundred and fifty-six treatments were given (mean 7.8 treatments/patient), and the relation between clinically observed seizures (COS) and the cerebral patterns of convulsions (EPC) was compared. If clinical observation alone had been used, restimulation would have been necessary in 43 per cent of the treatments, whereas restimulation actually was done in 9 per cent. Similarly, too violent convulsion patterns would have been ignored in 5 per cent of the treatments.

Plasma pancreatic polypeptide concentrations rise by 320±81 per cent following administration of electroconvulsive therapy. This rise is observed in the first ten minutes despite premedication of patients with 0.6 mg atropine. Pancreatic polypeptide release is dependent on cholinergic tone and is very sensitive to atropine. The dramatic rise in pancreative polypeptide observed following electroconvulsive therapy probably results from vagal stimulation and reflects insufficient atropine premedication.

Constipation is a frequent effect of treatment with antidepressant and neuroleptic drugs as a result of interference with neuronal control of colonic muscular activity. Motilin, a circulating peptide, is involved in induction of myoelectric complexes in the colon. Significantly elevated circulating basal motilin levels were found in patients receiving tricyclic antidepressant drugs, mean 128±33 pmol/l (control 48±6 pmol/l) or neuroleptic therapy, mean 213±29 pmol/l (control 87±8 pmol/l).

This paper explores the relationship between depression and chronic intractable pain in which somatic pathology is playing a minor role. In this study, 114 patients with chronic pain were compared with 53 patients with depression. Patients with chronic pain were older, more likely to be married, more frequently attributed difficulties in activity and sleep to pain, and reported greater impairment of motor functions. They had less dysphoria and an illness behaviour profile (on the Illness Behaviour Questionnaire) suggestive of a conversion reaction. Depressed patients recalled more life events in the year prior to presentation, whilst pain patients recalled more events of nine and ten years earlier. It is concluded that the two patient groups cannot be considered identical. It is argued that the concept of abnormal illness behaviour helps to distinguish the two groups.

A discriminant function analysis was carried out to separate a sample of 75 suicides from a sample of 146 attempted suicides, on which comprehensive clinical and social data were recorded on an identical schedule. Two sets of discriminating items (with 18 and 6 variables) correctly classified 91 per cent and 83 per cent of the two samples in their respective groups. The results provide a basis for examining the usefulness of these variables as predictors of future suicide in people who have attempted suicide.

In a comparison of assessment methods of severity of depressive illness, the Montgomery-åsberg Scale had, broadly, a performance equal to the Hamilton Scale. The Beck Depression Inventory, its subscale, and the Wakefield Inventory all had overall poor performances and should now be abandoned in research. The two-patient-rated scales were, overall, similar and fairly satisfactory measures. The comparisons were at points in severity of illness and not on change of severity.

Psychiatric manifestations were studied in 72 amputees in the post-operative period. All were right handed. Besides phantom limb phenomena, which were observed in nearly four-fifths of the cases and are described in another paper, nearly two-thirds had psychiatric symptoms in the form of depression (45 patients), anxiety (38), crying spells (38), insomnia (34), loss of appetite (23), suicidal ideas (21) and psychotic behaviour (2). Right arm amputees had phantom phenomena and insomnia significantly more often than left.

Nearly one-fifth of the cases were diagnosed as having psychotic depressive reactions, two-fifths as having depressive neurosis and two, both with right upper limb amputations, as schizophrenic.

Phantom limb phenomena during the post-operative period were studied in 72 amputees. All were right handed. Phantom limb was present in 86.1 per cent of the cases, significantly more commonly following amputation of the right arm. Nearly half of the phantoms developed within the first 24 hours and another quarter in the next 24 hours, appearing earlier in lower limb amputees. Movements in the phantom were felt by three-quarters of the cases, an incidence unaffected by site or side of amputation. Telescopy was present in nearly two-thirds and phantom limb pain in over two-thirds, significantly more commonly in the upper limb amputees but uninfluenced by the side of amputation. Thirty-one of the patients dreamed that their limbs were intact.

A classificatory system for mental disorders in the elderly proposed by Roth in 1955 was examined in a comtemporary population. Ninety per cent of patients could be allocated to the five psychosyndromes originally defined. Examination of outcome in the present sample, at six months and two years, showed important differences. The outlook for patients with paranoid psychoses showed an improvement though for those with affective illness (at 2 years) there was little change. Of special importance was the increased long-term survival of very elderly female patients with senile dementia. This, in conjunction with the general rise in admissions for mental disorders in the aged over the past 25 years, has considerable implications for the future development of psychiatric services for the elderly mentally ill.

A self-report Social Adjustment Scale (SAS-M) for use in British populations was devised by modifying the original North American version, and its usefulness was evaluated among 331 women drawn from two local populations. In a group of mothers of one year old babies (n = 130), high levels of agreement were found between the subjects' self-ratings on the SAS-M and (i) a psychiatrist's ratings of their social adjustment made at interview; (ii) ratings of the subjects' social adjustment made by their husbands on the SAS-M; (iii) measures of concurrent mental state. In a group of women undergoing elective sterilization (n = 201), the SAS-M was found to be sensitive to changes in mental state over time. Possible applications of the SAS-M in psychiatric research, particularly when an interview is not feasible, are discussed.

A randomized controlled study of 38 catchment unit psychiatric in-patients in a discussion group showed no significant additional benefit compared with 36 in-patients in an activity group. Symptom change scored by three rating groups agreed closely, average r = +0.64. Patients treated with ECT showed 2.6 times as much reduction in morbidity as those not so treated, but there was still no appreciable difference between discussion and activity groups when this was allowed for. Other treatment factors and the Hawthorne effect appeared to obscure any effect due to group therapy.

A case of procyclidine abuse is described in which the clinical presentation was indistinguishable from mania. The patient was a long-standing poly-drug abuser and was obtaining the drugs from medical sources. Controlled exposure on the ward to drugs of abuse, including a double-blind comparison with placebo, confirmed that procyclidine caused a manic response in this patient.

Three patients suffering from major depressive disorder with melancholia and unresponsive to a three-week trial of adequate dosage of phenelzine, received lithium. Each responded within a five-day period. The similarity to lithium augmentation of tricyclic treatment is noted and discussed.

In 107 patients on long-term lithium, those with lower plasma folate concentration had a higher affective morbidity than those with higher folate, both at the time and during the previous two years. The association was not the result of weight change or the concomitant use of other drugs. Animal work reporting a decreased synthesis of 5-HT both in folate-deficient animals and in animals fed excessive amounts of folate suggests that it may be important for lithium patients to receive folate supplements to their diet for maximum therapeutic effect.

The CT scans of 11 schizophrenics and 26 controls were evaluated for both linear (Evan's and cella media ratios) and volume (planimetry and grid ratios) measurements of ventricular size. There were no differences between the two groups on any of the measures obtained. These results are discussed in relation to previous reports showing ventricular enlargement in schizophrenics. The relatively younger age and briefer period of hospitalization in this present sample are suggested as variables possibly associated with these findings.

The reading matter one would recommend to medical undergraduate students clearly depends upon one's own view of the purposes and aims of teaching this group of students in departments of psychiatry. Aims may not be limited to psychiatry itself, and some teachers see the development of interviewing skills, self-awareness, and personal development as being at least as important as the teaching of more technical aspects of medicine such as the psychological aspects of physical disorders, recognition of psychiatric syndromes, psychiatric treatments, the use of the Mental Health Acts, and the organization of psychiatric services and their relation with other medical services.