Therapeutic factors operative in in-patient and out-patient therapy groups were compared. These settings differ greatly, both in terms of the patient population they serve and the overall systems within which they operate. The study revealed significant differences between the therapeutic factors operative in these two settings, and suggested that clinicians should modify their techniques for running psychotherapy groups across settings, to take account of these findings.

In 42 patients with cognitive dysfunction (senile dementia) significant correlations between immunoglobulins and various tests of intelligence were observed. Serum IgG emerged as the single best predictor of behavioural status. There is need for further research in this field.

There is a paucity of research concerning service usage and needs of female long-term psychiatric patients. A series of studies comparing the provisions for chronically mentally ill men and women in a south London community-focused rehabilitation and continuing care service indicate marked differences in the services received by men and women, and raise questions concerning whether the needs of female patients are adequately served. As a group the women had been in contact with services for longer, had received less intensive input from services, and it appeared that the services had been less responsive to their changing needs. Among those in high contact with the services, the functioning of men and women did not differ, yet women were over-represented in workshops designed for those functioning at a lower level. Women over 45 years of age seemed to be particularly badly served by the organised activities offered.

The purpose of this communication is to present a group of patients who, while receiving treatment with one of the phenothiazine derivatives in average range of doses regarded as suitable for adults, developed a syndrome comprising mutism and a number of other neurological features. In the majority of these patients speech loss is almost complete; but, unlike aphasics, they may respond to repeated questioning by simple utterances usually spoken in a whisper, or else are capable on rare occasions, quite unexpectedly, of delivering remarks which are appropriate and may be spoken normally. Speech deprivation is as a rule associated with an inability to communicate either by gestures or writing and also an inability to perform many customary tasks. Mutism is, therefore, not an isolated disability, but is associated with a wide range of disturbances of behaviour and of level of consciousness. In addition, some of the patients exhibit one or more of the neurological toxic phenomena encountered in the course of medication with phenothiazine derivatives, e.g. akathisia, buccal dyskinesias, dystonias, tremor and parkinsonism.

Two psychiatric day hospitals were evaluated in terms of the outcomes after three months' attendance by patients. Multiple measures were made using questionnaires, naturalistic observation, and ratings at the start and end of this period, for a total of 83 patients. The results indicated that although both day hospitals were serving similar patient samples, only one was achieving significant clinical improvements; one plausible explanation for the findings was the differences between their respective programmes. The major implication of the result is the need for evaluation of both the outcome obtained by patients following attendance and the therapeutic process by which these outcomes are achieved.

Recent reviews dealing with psychiatry in sub-Saharan Africa have stressed the overall similarity in the incidence of psychiatric conditions and their diagnostic distribution to those seen in other parts of the world (German, 1972; Giel and Van Luijk, 1969; German and Arya, 1969). All authors emphasize, however, that some clinical pictures seen in Africa, such as those of depression and anxiety states, vary from the manifestations one encounters in European and North American patients.

The main aim of this investigation is to determine whether patients with psychiatric illness have more somatic illness than those who are psychiatrically well, and conversely, whether those who have more than an average amount of physical sickness also suffer from an excess of psychiatric disability. A subsidiary purpose is to determine how much “psychosomatic” illness occurs in association with physical and with mental illness.

An inverse correlation between platelet monoamine oxidase activity and spontaneous eye-blink rate, a putative measure of central dopaminergic activity, was found in medication-free chronic schizophrenic patients without tardive dyskinesia (n = 20, rs = -.47, P <.025). A similar correlation was found when patients with tardive dyskinesia were included but was weaker (n = 27, rs = -.35, P <.05). Normal controls and patients with tardive dyskinesia did not demonstrate this relationship. This report confirms a previous finding of a significant platelet monoamine oxidase-blink rate correlation in chronic schizophrenic patients. Insofar as this relationship is mediated by dopamine, it suggests that dopaminergic relations are more readily demonstrated in schizophrenic subjects than normals. Moreover, tardive dyskinesia appears to obscure this dopaminergic relationship.

A number of factors have been proposed as being linked to schizophrenia: genetic, psychological, endocrinological, metabolic, environmental, virological, and auto-immunological factors, as well as neurotransmitter systems and structural disorders of the brain. All may act as predisposing, triggering, or functionally modulating factors in what is probably a condition composed of several types of disorder with varying aetiology. Neuroanatomical and neuromorphological data have revealed ventricular enlargement and diminished frontal and temporal lobe volume in some patients. These changes are concentrated particularly in the hippocampus/parahippocampal gyrus/amygdala, but are relatively small and span some overlap with healthy subjects. Twin studies suggest that at least some of these changes may result from other than genetic factors. Functional disturbances of the brain have also been connected with frontal and temporal structures in some schizophrenic patients. Of the single neurotransmitter substances, dopamine and serotonin appear to represent some of the central restitutive mechanisms whose function is to maintain mental stability; the understanding of their interplay with other neurotransmitters such as noradrenaline, acetylcholine, GABA, and glutamate, should provide a more integrated view of both normal and disturbed brain function.

This evaluation of the Time to Change anti-stigma campaign in England represents a milestone in international stigma research. While showing some positive outcomes, the overall picture is mixed and falls short of the wholesale shift in attitudes that is needed. A new approach is proposed for the coming decades.

In this editorial, we argue that current attitudes toward terminally ill patients are generally too paternalistic, and that it is wrong to assume that patients suffering from mental health issues (including depression) cannot consent to assisted suicide.

In the development of psychiatric genetics progress has been very largely dependent on the progress of clinical psychiatry. In the early days the theory of polymorphism held the field—that is the idea that there is a single hereditary basis for what may be called degeneration, which might show itself in many forms, any form of insanity, psychopathic character, criminality or mental defect. This theory was built up on the unclear psychiatry of the day, when the boundaries between different clinical states were vaguely drawn and largely in dispute. We are now passing out of this stage in clinical psychiatry, but the genetic theory that was built on it, the idea of polymorphism, still lingers on. It has been the stimulus to an immense amount of muddled research of no value. The time has come when this theory should be finally discarded. We are not entitled to think that different clinical conditions have the same genetic basis until such has been proved. From a factual point of view the accumulation of knowledge has shown it in a number of cases to be untenable. From a heuristic point of view it offers no possibilities of advance.

“Dementia Praecox” was discarded when it became apparent that a true dementing process was not present in schizophrenia. Most writers agree with the view put forward by French authors that the deterioration in schizophrenia is not the same as that seen in the organic psychoses (Lehrmann, 1940). Experimental work has indicated that intellectual deterioration in schizophrenia is more apparent than real, and that as it appears most when sustained effort and co-operation are required, any changes in co-operativeness and ability to maintain sustained effort invariably affect intelligence test scores (Kendig and Richmond, 1940; Sheldon Rappaport, 1951). The concept of schizophrenic deterioration employed in this article refers to a deterioration of behaviour in general, and to a deterioration of a patient's ability to look after himself in particular. With increasing interest in methods of treating deteriorated schizophrenic patients, we need reliable measures of deterioration in order to compare the effects of treatment in different groups. At present discrepancies in results are frequently due to some groups of schizophrenics being more deteriorated than others. For example Layman (1940) demonstrated that sodium amytal speeded up the psychomotor performances of schizophrenic patients, but subsequent work by Ogilvie (1953) did not confirm this finding. This discrepancy may have been due to the fact that Layman's schizophrenic group contained patients who were more deteriorated than the patients in Ogilvie's study. If a scale indicating the degree of schizophrenic deterioration could be devised, future researches into the treatment of deterioration in schizophrenia would benefit. There are a number of rating scales already available of which the best is probably the Fergus-Falls (Lucero et al., 1951). All of these scales have several common defects. They contain a number of items which are very subjective in nature and dependent more on the rater than the patient. Many are also of such length that they are too time-consuming to complete, particularly in the case of patients on long-stay wards where the nursing staff are invariably overworked already.