Volunteer college students completed a categorisation task designed to test the hypothesis that adults organise their expectations of relationships in a manner that reflects a functional distinction between attachment and affiliation. Terms associated with the provision of security and with characteristics theoretically identified as definitive of attachment relationships were significantly more likely to be associated with the relationship identified as ‘lover’. There was substantial overlap between attachment and affiliation relationships in functions relating to intimacy and disclosure. These results highlight the need to differentiate close relationships by functional rather than structural characteristics.

The nomenclature of neurology is already so extensive and so chaotic that every proposed new term requires its apology and precise definition before being accepted—just as every term, new or old, should be weeded out, if it cannot be given a satisfactory definition.

This report is published with the blessing of the College authorities, although they would challenge one or two elements in it. The main points of contention would be, first, the definition of wastage (it is understood that some of the students who are classified in the report as “wasted” did in fact go on to degree courses in other subjects elsewhere, having realized that they had chosen the wrong subject at first); second, that to quote a single year's figures may be misleading, since there are reasons for thinking that the picture may be changing for the better; and third, that academic inadequacy and idleness are thought to be at least as prevalent, as reasons for failure, as psychological disturbance, whereas this investigation concentrates almost exclusively on the latter.

Mental health services are of interest not only because of the large burden they impose, but also because they have been subject to more change than virtually any other type of health service over the past four decades. Although both the US and UK have taken to ‘deinstitutionalisation’ with enthusiasm, the US has so far proceeded somewhat further down that road than the UK. While both countries face similar problems, the NHS and Community Care Act 1990 may now lead to considerable further changes in the UK.

250 patients referred to a department of psychiatry for the deaf were selected by random sampling and studied. The results underline the need for specialised services for deaf patients of all types, not only those who communicate solely by manual methods. Patients are referred to this department suffering from mental illness and communication disorders, as well as from problems related to their deafness. Some of the difficulties of managing a supra-regional service are discussed.

A 20-year-old man developed generalised rigidity and signs of autonomic instability following the introduction of therapy with zuclopenthixol decanoate. A diagnosis of NMS was made, despite the absence of hyperthermia. He recovered on treatment with thiamine, dantrolene, and bromocriptine.

Schizophrenics appear to be unable to regulate adequately the effects of external stimulation, but the cause of this deficit is unclear. Recent evidence suggests that input activation can normally be inhibited by an appropriate leading or conditioning stimulus; such inhibition has been found to be diminished in schizophrenics. Based on this evidence, a feed-forward regulating mechanism that serves to stabilise reactivity to environmental events is described; it is hypothesised that failure of the mechanism to inhibit adequately surges of activity is an underlying cause of schizophrenic symptoms. Some ways to test the validity of the mechanism are proposed, and an outline presented of steps to link the mechanism's dysfunction to schizophrenia.

The severity of depression in 11 drug-free unipolar patients diagnosed with definite major depressive disorder was assessed using the Hamilton Rating Scale for Depression during a course (5–10 treatments) of bilateral electroconvulsive therapy (ECT). The degree of improvement after three treatments of ECT was six times greater than the improvement that occurred over the remainder of the course. Although depressed patients who recover with ECT require repeated treatments, the treatments early in a course of ECT can have marked antidepressant effect.

The writings of Franco Basaglia are critically reviewed, both from a technical psychiatric point of view and from a general political and social one. Basaglia maintained that the causes of psychiatric disorder are essentially social in nature, and that the only valid treatments are political struggle and the revival of the patient's aggressiveness. Therefore, no institution can be therapeutic for the patient, since its aim must be his custody and violent destruction. These statements are considered in the light of the need for institutions which are a therapeutic alternative to the mental hospital. Basaglia's ‘liberal’ defence of the individual against society is analysed, in relation to the negative consequences that the Italian Law 180 of 1978 is having on the care of long-term psychiatric patients. This law ‘forgot’ such patients, as well as adversely affecting the treatment of acute patients, for whom an insufficient number of psychiatric beds was permitted in general hospitals. A revision is proposed of Law 180 that would make possible the setting up of alternative institutions to outdated mental hospitals, but at the same time allow a transformation of their old structures.

A prospective study of 45 cases, 25 of whom had had previous episodes of affective disorder, predominantly manic, showed further episodes in 14 cases. A positive history of psychotic disorder in 1st-degree relatives, not always affective, was obtained in only eight cases. There was a history of drug abuse in seven patients. The clinical presentation in the Nigerian patients was similar to that described in the classical literature, but, flight of ideas was uncommon.

One purpose of cognitive-behaviour therapy is to provide patients with a ‘psychological model’ of their illness; this would enable them to become aware of, and thereby gain insight into the ways that the symptoms and behavioural deviances they exhibit, and the circumstances of the onset of illness are actually related to their previous experience and social learning (for overview see Hawton et al, 1989). This concept provides a basis for gaining greater insight into special therapeutic interventions, and should help patients to develop their own lifetime methods of coping with problems.

Lymphocyte response to stimulation with phytohaemagglutinin (PHA) was assessed in 11 patients with major depression and 8 subjects anticipating bereavement, in order to examine whether altered immune response (PHA stimulation index) was more closely related to depressed mood than to sleep and weight changes. No significant relationship was found between sleep or weight changes and immune response. Depression, measured using the HRSD (with and without sleep scores) and the BDI, was related differently in the two groups. For the depressed patients, increasing depression was associated with reduction in immune response; among those anticipating bereavement (with low depression scores), increasing depression was associated with enhanced immune response. A regression curve using data from both samples demonstrated an inverted ‘U’-shaped curve relating immune response to mild and severe depressed states. The results of this study suggest a hypothesis that may explain previous discrepant results and which requires testing on more subjects.

Changes in relatives' affective attitudes are important contributors to the impact of family psychoeducational programmes on the course of schizophrenia. It remains unclear whether similar changes occur in the interactional style of schizophrenic patients participating in psychoeducational treatment. This study examined changes in the interactional style (coping style) of 33 schizophrenic patients in individual or family treatment. Significant changes were seen in the interactional style of the patients participating in the individual treatment. Similar changes were evident, but not significant, in the family treatment group. The quality of patient interactional style before or after treatment did not predict relapse in either group. Changes in relatives' interactional style early in family treatment are necessary to affect the short-term course of schizophrenia. Modification in patient behaviour during the early phase does not have similar predictive value.

A review of studies relating suicide to the menstrual cycle (Wetzel et al., in preparation) showed that an increased proportion of female suicides and attempted suicides probably occur during the luteal (from ovulation to onset of menses) and menstrual phases of the cycle. Mandell and Mandell (1967), in a study of women calling the Los Angeles Suicide Prevention Center, found an increased number calling in the late luteal and menstrual phase of their cycle. This study assessed the relationship between phase of the cycle at the time of call and self-judged lethality.

A Republic of Ireland national survey of electroconvulsive therapy (ECT) showed wide inter-hospital variation in ECT rates. Psychiatric admission rates, professional attitudes, and patient turnover were found to predict these rates. No significant association was found between ECT rates and public/private care or other socio-economic factors. A limited examination of British admission data revealed a similar set of correlations, suggesting that the findings may apply in non-profit health-care systems outside the Republic of Ireland.

Nortriptyline plasma levels and the incidence and severity of the common subjective side effects of the tricyclic antidepressants were determined in 26 patients during six weeks of treatment with nortriptyline. The total corrected (treatment minus pre-treatment) score of the eight side effects most independent of the severity of depression correlated (0 · 60) with the nortriptyline plasma level. Increased perspiration (o · 59) and dry mouth (o · 54) were the individual corrected side effects which most consistently correlated with the plasma level. These subjective side effects may serve as clinically useful guides to dosage adjustments during treatment, though their value is limited by the magnitude of the correlations and the need to correct for their presence prior to treatment.

The authors report a patient whose Parkinson's disease and mania both responded well to electroconvulsive therapy (ECT) after failing to respond to chemotherapy. The authors review the literature and suggest that ECTis a safe and effective treatment for affective syndromes associated with Parkinsonism. The presence of dementia in these patients appears to be an indicator of poor prognosis. This paper is believed to be the first report of successful use of ECT in mania occurring together with Parkinsonism.

Psychotropic agents are widely prescribed. The effects of a drug represent a complex interaction between the chemical agent, the individual patient and the environment in which the administration of the drug takes place. Many patients use alcohol (a C.N.S. depressant) and control complex machinery. It is necessary to know how a drug interacts with alcohol and especially how it affects driving skills. Murray (1960), in a 90 day study of 68 drivers on chlordiazepoxide, found that traffic accidents were ten times more frequent than the predicted control rate. Zirkle et al. (1959) established that chlorpromazine had “a supplementary and possible potentiating effect” on the impairment of co-ordination and judgement produced by alcohol in 24 human subjects.