Two dominant themes of alcohological thinking and practice are considered in this paper; the disease concept and the concept of motivation. Both are examined in terms of (a) the rights, obligations and responsibilities associated with different types of illness and degrees of severity, and (b) the routine care and treatment of alcoholism in two out-patient alcoholism clinics. The allocation of responsibility and attribution of motivation in psychiatric alcoholism consultations are examined. Finally, the relationship between responsibility allocation, motivation attribution and judgements of a potentially moral nature is considered. It is concluded that a Mutual Participation model of sickness behaviour and doctor-patient relationship is operative in the psychiatric treatment of alcoholism, based upon patients' self-responsibility and strength of character (willpower). In this respect, the psychiatric treatment of alcoholism contrasts with other (particularly non-psychiatric) conditions and treatments.

The stability of self-report of 72 skid-row alcoholics over a one to six month interval was explored. Relatively high response agreement on reinterview was indicated for demographic items, but less reliability was observed on items assessing social functioning and drinking patterns. Implications of the findings for the evaluation of treatment programs are discussed.

In an attempt to evaluate the clinical significance of alcohol withdrawal, the rate of symptoms and incidence of treatment were determined in 84 female alcoholics following abrupt withdrawal. Results indicated that abstinence symptoms of an emergency type (delirium tremens, convulsions) only rarely occur and require active treatment, whereas those physical and emotional disturbances frequently seen in alcohol withdrawal need very little medical help. This finding is in contradistinction to current clinical opinion.

Eight male schizophrenics were treated in an open study with d.l. propranolol. The dose was increased by 160 mg/day until a maximum of 2,400 mg/day was achieved on day 15, and this remained constant until day 21. Seven patients showed significant clinical evidence of psychiatric improvement, while the incidence of toxic side-effects was low. There was wide inter-patient variation in plasma levels of propranolol. Despite a significant increase of plasma propranolol between day 15 and day 21 of the study, there was no significant change in serum prolactin.

Pseudocholinesterase activities and phenotypes have been determined in 103 affectively ill patients, 168 schizophrenics and 73 Huntington's disease sufferers and compared with those of a sample of healthy controls. The distributions of phenotypes in the patient samples did not differ significantly from those of the controls.

When corrections were made for sex, age and E1 phenotypes, the Huntington's disease patients showed a reduced level of cholinesterase activity. Normal levels were found in affective disorders and schizophrenia.

Approximately two thirds of a group of bipolar patients attending the routine lithium clinic suffered side effects. These patients tended to have a lower plasma and erythrocyte lithium concentration and a lower erythrocyte/plasma lithium ratio than those who had no side effects. Explanations of this unexpected finding are discussed.

Finger tremor and extrapyramidal side-effects (EPSEs) were measured in seven patients before and during neuroleptic drug treatment to assess the relationship between the onset of EPSEs and changes in finger tremor spectra. Tremor and EPSEs were also measured in twelve patients stabilized on neuroleptic drugs to determine whether tremor could provide a reliable index of the presence and severity of extrapyramidal system disturbance. A downward shift in peak tremor frequency was noted within 48 hours of starting neuroleptic drug therapy, usually before the onset of EPSEs, and a significant negative relationship between the severity of EPSEs and tremor frequency (but not tremor amplitude). The peak frequency of finger tremor is thus a sensitive index of extrapyramidal disturbance and might be of value in predicting which patients taking neuroleptic drugs need anti-parkinsonian therapy.

Averaged cortical evoked responses to auditory and somatosensory stimuli were recorded in elderly depressives, dements, patients with a combination of depression and dementia and normal elderly controls. The subjects were also given a battery of cognitive tests and clinical ratings at stated intervals.

The latency of the auditory response was significantly longer in dements than in controls. Depressives had intermediate latencies which did not return to normal after recovery. Although somatosensory stimuli produced the results that pointed in the same direction, the mean response latencies were not statistically significant. Mixed cases were too few for separate statistical analysis but their latencies fell between those of the dements and those of the depressives.

Significant correlations emerged between latencies of auditory responses and some cognitive tests, but not with measures of depressive symptomatology.

The delay in response to auditory stimuli may be a useful adjunct to diagnosis: in depressives it may reflect organic cerebral change playing a part in the emergence of depressive symptoms in old age.

A trial was carried out of Reality Orientation (R.O.) in a residential home for the elderly mentally infirm with a ‘social therapy’ control group, receiving the same amount of staff attention as the R.O. group, in addition to an untreated control group. R.O. residents improved more on tests of information and orientation and various aspects of memory than controls. These results support the hypothesis that the nature of staff attention is crucial and that it should encourage and reward appropriate behaviour. No differential effects of treatment were found on rating scale assessments of the residents' functioning in the home.

The 30-item General Health Questionnaire (GHQ) has been validated against the criterion of a standardized psychiatric interview in the community. Used for screening, the GHQ misclassified 25 per cent of 105 respondents, being worse for men. Specificity and sensitivity were above.70. The alternative use of the GHQ as an estimator and as an indicator of morbidity in epidemiological surveys is described and discussed.

Statistical and requirement difficulties encountered with existing methods of Repertory Grid Analysis are considered. A simple purpose-built method of Cluster Analysis is outlined, and its extension to the difficult problem of comparative analysis described.

The life of Havelock Ellis is described; his personality and life experiences are related to the writing of his major work. Important sections of the ‘Studies' are summarized and their relevance to contemporary sexology is emphasized.

The changes in pituitary gland function in mental illness are under intensive study. This is because the regulation of pituitary function by the brain involves monoamine neurotransmitters, and changes in hormonal secretion may thus reflect general fluctuations in monoamine activity in the brain. Characteristic patterns of change of diagnostic and therapeutic significance may also emerge. Thus, adrenocorticotrophic hormone secretion and adrenal corticosteroid activity are enhanced in depression, largely through the occurrence of additional secretory spikes of ACTH and the lack during the late evening or early morning of the normal fall in Cortisol secretion. Dexamethasone is less able to inhibit ACTH secretion in depression, while a fall in plasma glucose may less readily induce growth hormone secretion (Ettigi and Brown, 1977; Gruen, 1978). Nevertheless, there is no assurance that a monoamine neurotransmitter system concerned with pituitary function is affected in the same way as one influencing psychic outlook.

In 1929, George W. Henry published a paper on ‘Some Modern Aspects of Psychiatry in General Hospital Practice’ and thus became the founder of what later came to be known as liaison psychiatry. He described his work as a psychiatric consultant at Cornell Medical School and advised that ‘On the staff of every general hospital there should be a psychiatrist who would make regular visits to the wards, who would direct a psychiatric out-patient clinic, who would continue the instruction and organize the psychiatric work of interns and who would attend staff conferences so that there might be a mutual exchange of medical experience and a frank discussion of the more complicated cases'. This quotation spells out the essence of psychiatric liaison with medicine. The work of Henry and a few other pioneers bore fruit: psychiatry was at last brought into general hospitals and the mainstream of twentieth century medicine. This was a development of far-reaching consequence for both clinical disciplines, and a major landmark in the history of modern psychiatry.