The word “oecology “was coined by Hacckel in 1869, and the study of the complex interactions between organisms and their environment led to fruitful results first in botany (at the beginning of the twentieth century) and later in zoology. In 1935 Bews formulated the principles of human ecology, but the precise boundaries of this discipline (as Banks (1905a) calls it, since it cannot be called a science) are still not the subject of any general agreement. Its dictionary definition as “that branch of biology which deals with the relations of human beings to their surroundings, their habits and modes of life,” although simple for the purposes of formulation, is probably too diffuse in practice. On the other hand, Miller (1950), in suggesting that the ecological study of disorders should be confined to their distribution in the purely demographic sense, seems unduly to restrict its application. There is a tendency among American ecologists (who have been the pioneers of this subject) to take a middle course. Park (1936) conceives of human ecology as the study of the community in terms of the competitive forces which mould it, as opposed to the cultural forces which make for social co-operation. Similarly, Faris (1944) distinguishes the ecological order, which arises automatically and unintentionally out of the struggle for survival, from the cultural order, which is based on mutual affection and sentiment.

This paper attempts to describe some of our electrodermal data and its relationship with environmental factors and the outcome of a psychosocial intervention study with families of schizophrenics. In the context of the heuristic vulnerability/stress model of the development and course of schizophrenic episodes described by Nuechterlein & Dawson in 1984, there is an interaction between individual vulnerability factors and external environmental stressors with resulting effects on the hypothesised transient intermediate states of: processing capacity overload, autonomic hyperarousal and a deficient processing of social stimuli. Accelerating dysfunctions in these systems result in the reappearance of characteristic schizophrenic psychotic symptoms. The purpose of our work has been to investigate the interface between the individuals' biological and environmental systems.

Extensive lesions of the frontal lobes are followed by pronounced personality changes. This has been shown beyond doubt by the effect of neuro-surgery performed for the removal of brain tumours or for the relief of mental illness. To identify such changes and the lesions responsible for them at least four conditions seem necessary: (a) Knowledge of the limits, variations and connections of the main pre-frontal areas.—In this field the researches of Professor Alfred Meyer and his associates, Mrs. Beck and T. McLardy, are of primary importance (1950).

Convulsive therapy as a form of treatment for schizophrenia originated very soon after insulin coma treatment and the induction of convulsions by an electric current was first used by Cerletti and Bini in 1938. For many years insulin comas were regarded as the treatment of choice, although E.C.T. was recognized as having some value, particularly in catatonic conditions. In the last eight years the advent of effective chemical therapy with the tranquillizers has tended to overshadow the value of any other form of treatment.

A study of familial and social factors among Jewish and Protestant depressives and non-psychiatric controls revealed the following positive findings:

Depressives compared to normals as a whole had: (a) a higher rate of psychiatric illness in their families; (b) lower scores on maternal overprotection; and (c) a higher rate of marriage in both ethnic groups and both sexes, except in the case of Jewish men. Religiousness was associated with depression among Jews but not among Protestants. Jewish fathers compared to Protestant fathers were: (a) less strict in the normal group; and (b) less strict, less ‘dominant’ and more ‘inadequate’ in the depressed group. Ethnic links among depressed Jews were probably weaker than those among depressed Protestants.

The findings suggest that: (a) depression among Jews may be related to mental stress arising from ‘marginality’; and (b) single Jewish men may be particularly vulnerable to depression.

Procyclidine was administered to 25 chronic psychotic inpatients, stabilised on chlorpromazine, haloperidol or fluphenazine decanoate injection. We observed a significant reduction in mean serum levels of all three neuroleptic drugs which was reversed on stopping procyclidine and was Inversely correlated with mean serum procyclidine levels. No significant alterations occurred on the BPRS scores or in serum prolactin levels throughout the study In any of the three groups. Possible mechanisms of this interaction and its clinical relevance are discussed.

The association between renal papillary necrosis and prolonged ingestion of compound analgesics containing aspirin and phenacetin, has been widely reported (5, 6, 11, 13, 17, 19, 20, 24, 42). Although formerly thought to occur mainly in Switzerland, Scandinavia and Australia, analgesic nephropathy is now being increasingly reported in Britain (3, 26, 36), and in particular in Western Scotland (33). In the past seven years over 100 cases have been seen in the renal unit of the Western Infirmary, Glasgow, and, of these 42 have died in uraemia.

There are in the eyes of the world different sorts of ‘good’ psychiatrists. It depends who is making the judgement; it depends what is asked of the psychiatrist, what role he is expected to take and how successfully he has measured up to it. One would expect that the qualities of a doctor would be judged to a very large degree by his capacity to treat patients. This is what his long period of undergraduate and postgraduate training and education is about. Recently this concept of the doctor, and particularly that of consultant psychiatrist, has been challenged. The expectation that in the future he will continue to treat patients personally seems to be doubted. I wish to make my own attitude clear at the outset. The psychiatrist in my view is a physician in psychological medicine—a clinician—which means that his business and his professionalism are the personal care of patients. He is now called upon to do much more than this, and the reasons are several and complex. But the old view of a psychiatrist as physician may be lost if he accepts only the role of administrator, PR man, member of a multiprofessional team with far-ranging, ubiquitous responsibilities.

Of 30 agoraphobic married women undertaking home-based behaviour therapy, 15 each had a female friend as co-therapist and 15 had their own husband as co-therapist. At 12 months follow-up, women spent a mean of approximately 40 minutes a day more outside the home alone than at baseline. Women assisted by female friends made somewhat more behavioural gains than those assisted by husbands. Women in both groups whose husbands had been more depressed 2 months after the beginning of therapy did less well at 6 months. Husbands who become more depressed may retard their wives' progress in therapy, but the effect was small, and was outweighed by other considerations.

A historical review of suicide in Fiji shows that rates for people of Indian descent have always been higher than those of other groups, yet until now this phenomenon has attracted little official or public attention. Recent changes in the incidence and methods of suicide have led to the introduction of some preventive measures, but the emphasis has been on eliminating some of the methods rather than the reasons for suicide. The continuing high incidence of suicide by hanging involving some sectors of society appears to have been overlooked. Possible causes of this apparent lack of interest are examined, such as the low status historically of Indian immigrants and concepts held about them by other groups in Fiji, and the ‘invisibility’ of groups of people such as rural women and the aged.

The literature on referral of patients by GPs to psychiatrists and mental health specialists is examined. Referrals to psychiatrists account for 3% of all those made by GPs, but the individual rates vary widely. The proportion of patients referred to psychiatrists and paramedical mental health workers in general practice is unknown, but probably substantial.

The sheer volume of new drugs introduced into psychiatry within the past decade has created an urgency to get to the point as quickly as possible: Is Drug B better than A, and, if so, what about B and C? With some abatement of the tide of new compounds it becomes possible to look, not just for a quick answer, but at some of the conditions of the trial which determine the outcome.

The extent of crime, vagrancy, death, and readmission in a prospective cohort of long-term mentally ill patients was measured during their first year out of hospital. All 278 long-stay psychiatric patients discharged during the first three years (1985-1988) of the closure of Friern and Claybury Hospitals were included. One patient was imprisoned, one committed suicide, and one became vagrant; five others may also have become vagrant. The mortality rate was similar for the leavers and their matched controls, who remained in hospital. There was one suicide among the matches. Mental deterioration most often caused readmission. On recovery, most patients returned to their community home. Six per cent of the cohort were readmitted and have remained in hospital for a year or more. With careful planning and a financial ‘dowry’ for each patient, the closure of large mental hospitals does not lead to a marked increase in vagrancy, crime, and mortality for the long-term mentally ill. However, the patients who have yet to leave have more problems of social behaviour and are likely to be more difficult to resettle.

All the papers about flat dwelling (Central Housing Advisory Committee, 1952; Hopper, 1962; Hird, 1966; Fanning, 1967; Gunn, 1968; Gilloran, 1968 and Stewart, 1970) except one (Sheerboom, 1962) state that it has an adverse effect on mental health. They are almost unanimous in naming the care of children as a cause. The best study from a scientific point of view (Fanning, 1967) showed a significantly higher rate of psychiatric consultations among those living in the same flats as in the present study. This was thought to be due to social isolation caused by the nature of the flats and being confined in them by children. A widely held belief that bad housing can cause or aggravate mental illness is not justified by the evidence. Three investigations (Martin, Brotherston and Chave, 1957; Wilner, Walkley, Schram, Pinkerton and Tayback, 1960 and Hare and Shaw, 1965) failed to show any benefit to mental health from new housing. The only one (Taylor and Chave, 1964) to find an improvement studied new housing which was socially planned. All four studies failed to allow for two other variables. One was the adverse effect of the move itself (Maule and Martin, 1956; Hall, 1964 and Shepherd, Cooper, Brown and Kalton, 1966) on those in new housing. The other was moving to better old housing among controls (Wilner et al., 1960).

Klinefelter, Reifenstein and Albright (13) in 1942 collected and described nine cases of a new clinical syndrome, later given the eponym Klinefelter's Syndrome, which appeared at puberty in males and was characterized by gynaecomastia, hypogonadism, aspermatogenesis, increased follicle-stimulating hormone (F.S.H.) and normal or low 17-ketosteroid urinary excretion.

There can be few more impressive sights in contemporary neuroscience and biological psychiatry than the imaging of neurotransmitter receptors in the brains of living human subjects by positron emission tomography (PET; Sedvall et al, 1986). How has such technology advanced our understanding of the pathophysiology and/or treatment of major psychiatric disorders?

Psychiatric patients frequently make somatic complaints which are not related to physical pathology, but this is often not fully appreciated by medical practitioners other than psychiatrists. Dowling and Knox (1964) have shown that depressive patients are often diagnosed as physically ill, especially if they have had a notable physical illness in the previous five years. Stoeckle and Davidson (1962) note that depressive patients are frequently referred to medical and surgical clinics and sometimes receive inappropriate treatment as a result. Sainsbury (1960) showed that gynaecological patients are, on average, more neurotic than normal. The present author (Munro, 1964) found that depressive women were excessively liable to have undergone a gynaecological operation in the year preceding their admission to psychiatric hospital.

In order to study putative differences in central neurotransmitter function in depressive subtypes, serum Cortisol and prolactin responses to the putative serotonin agonist fenfluramine were examined in 30 subjects with major depression. Patients with endogenous depression (melancholia) as defined by each of ICD–9, DSM–III, RDC and Newcastle scale demonstrated a reduced prolactin response to 60 mg oral fenfluramine when compared with non-endogenous subjects. This was independent of either prolactin or Cortisol baseline levels, and indicates that there are differences in brain neurotransmitter function in the endogenous and non-endogenous subtypes of depression. Basal prolactin levels were reduced in bipolar compared with unipolar subjects, and delusional compared with non-delusional patients, although there were no differences in the prolactin responses to fenfluramine between these subgroups. Basal Cortisol levels and Cortisol response to fenfluramine did not distinguish between any of the subtypes.

The 28-item General Health Questionnaire (GHQ) has been validated against the criterion of the Clinical Interview Schedule (CIS) in Spanish patients in hospital with several types of endocrinological illnesses. The screening instrument correctly identified 91 of 100 respondents as exhibiting psychiatric disorder. The questionnaire's efficacy was similar at the time of medical discharge, when the rate of disorder was significantly lower. Significant correlations were found between GHQ total scores and endocrine blood measures in Addison's disease, and in Type I diabetes. The four subscales of the GHQ sum to provide additional information concerning somatic symptoms and anxiety.