Studies of the relation between birth rank and schizophrenia (or any other disorder of adults) have hitherto been based on the assumption that, for a null hypothesis, cases will be randomly distributed among the birth ranks. In other words, if the distribution of cases is found to depart significantly from random (i.e. from equal numbers in each birth rank for each sibship size) then an association between birth rank and the disorder is held to have been demonstrated. However, we have recently shown, both from theoretical considerations (Price and Hare, 1969) and from the study of a large sample of psychiatric patients (Hare and Price, 1969b), that birth-rank distribution may depart very significantly from random because of bias arising from changes in the birth rate of the general population. The amount and direction of this bias will depend both on the changes in family size and on the number of families being started during the period of time when the patients (or any other population sample) and their siblings were born. The amount of bias is thus likely to be different in geographically different populations or in the same population at different periods of time.

There have been few published reports of the use of E.C.T. in delirious states complicating organic illness. Most psychiatric textbooks with adequate accounts of modern physical treatments allude only briefly to its use in these states, and few medical textbooks mention it at all. Yet the problem of the management of the acutely disturbed delirious patient is not a rarity in medical and surgical wards; in varying degrees delirium may accompany most serious illnesses and prognosis worsens with its persistence. For these reasons it is thought worth placing on record the following cases.

The case records of patients with organic delirium admitted in the past fifteen years to the psychiatric unit of St. George's Hospital were examined. Those cases receiving E.C.T., all seriously disturbed and otherwise unmanageable, are reported in this paper.

Time judgments of various kinds are often disturbed in schizophrenia, but a review of the literature (Orme, 1962) suggests the disturbance is not characteristic in type. The present writer has studied (Orme, 1964) the verbal estimation of an elapsed “filled” interval with various clinical groups. Subjects were asked, after 30 minutes of interviewing, “How long have we been together, how long does it seem to you?” A summary of the distribution of time estimates is given in Table I. The most statistically significant feature (see Orme, 1964 for details) is the contrast between the hysteric, psychopathic and manic groups on the one hand, and the melancholic, anxious and depressed neurotic on the other. Individual variations in estimates appear unrelated to age, sex and intelligence.

A retrospective study was carried out of 79 patients with subacute or chronic subdural haematomata. Forty-six (58.2%) had mental changes at admission which were categorised using DSM-III criteria. Delirium was the most frequent mental change, followed by dementia and coma. Three cases of organic affective syndrome were found. In those with mental changes, delirium was significant in older patients (P <.05) and coma in young patients (P <.001). Dementia was more common in the elderly. These findings confirm the presence of common mental syndromes in patients with subdural and haematomata and substantiate time-honoured clinical stereotypes.

Pellagra with marked mental symptoms in a boy of 10, was cured by nicotinamide (Hersov, 1955). The boy's diet prior to development of the pellagra did not however appear to have been deficient in nicotinic acid derivatives. The following studies were initiated in search for a metabolic peculiarity which might explain this.

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 syndrome of acute catatonic delirium associated with fever and usually with a fatal outcome was reported over hundred years ago. The first to describe it was Calmeil in 1832 (cit. after Aronson and Thompson, 1950). Kraepelin (1904) includes these states in the group of “akute Verwirrtheit”. Most authors emphasize the acuteness and high mortality of these states. Thus Claude and Cuel (1927), Guiraud and Saunet (1938), Golse and Morel (1953), call them “délire aigu”, de Simone (1962) “catatonie pernicieuse”, Stauder (1934) “tödliche Katatonie”, Huber (1954) “lebens-bedrohliche Katatone psychosen”, Knoll (1954) “perniziose Katatonien”. English writers call them “acute lethal catatonia” (Fisher and Greiner, 1960), Scandinavian “delirium acutum” (Lingjaerde, 1954). In Russian journals one finds them described as “delirium acutum” (Agieeva et al., 1955; Molokhov, 1962), “ostrij bried” (Rohlenko, 1961) or more recently “hypertoxic schizophrenia” (Romasienko, 1962).

A total of 150 psychiatric patients—schizophrenics, affective psychotics and neurotics—were compared with 150 normal controls for handedness. Schizophrenics were significantly more likely to be non-dextrals (i.e. not completely right handed) than controls. Affective psychotics and neurotics were not significantly different from controls.

Lindsten (5), Mellbin (7), and Pitts and Guze (8) have described a total of three cases of anorexia nervosa occurring in conjunction with gonosomal aneuploidy (Turner's syndrome or gonadal dysgenesis with XO sex chromosome pattern). The incidence of both conditions is low, and the small likelihood of their concurrent appearance in one individual by chance can be estimated from the following figures. According to Maclean et al. (6), the XO chromosome abnormality occurs in four out of 10,000 live births. Baikie et al. (1) have found that the incidence of the XO gonosome pattern in the general population is not significantly different from that at birth. Anorexia nervosa has an average annual incidence of 45 (Theander (9)) or 61 (Kidd and Wood (4)) cases per 10,000,000 people. On the assumption that the two conditions are independent, the probability of their occurring together would therefore be 0.18 to 0.24/100,000,000. Since the incidence data for the XO anomaly and for anorexia nervosa were obtained from different populations, it must be recognized that these figures are only order of magnitude estimates. Nevertheless, we considered it of interest to examine the available case records of anorexia nervosa patients seen at the University of Iowa Hospitals from 1920 to 1972 for Turner's syndrome and other anomalies of the urogenital tract.

The prescribing of psychotropic medication to 96 attenders at a lithium clinic was compared with their prescriptions while inpatients. As outpatients, they received fewer psychotropic drugs fewer times a day. This suggests that psychiatrists do not adopt intransigent stances in favour of polypharmacy and irrational psychotropic prescribing, as previous studies have implied. Caution is advised before attributing apparently irrational prescribing to bad clinical practice, or advocating remedial action aimed at changing the habits of prescribers.

The prospective, successful, use of ECT in a patient with a frontal meningioma is described. The authors review the literature on ECT in patients with brain tumours, and suggest factors predictive of a favourable outcome.

A new community psychiatric service in Nottingham based on general practice clinics was compared with a conventional hospital-orientated model. Despite providing treatment for an inner-city population of significantly greater social disadvantage, the community service was associated with similar levels of symptom morbidity as assessed by the CPRS and the SFS. It also involved greater use of day-hospital facilities, more extensive multidisciplinary care, and a commitment to longer-term follow-up of chronically ill patients. Such a model is offered as a basis for future developments of urban community psychiatric services.

The recognition of the need for psychiatric services for disturbed adolescents led to the opening of the first two adolescent in-patients units in Great Britain in 1949. As a result of community pressures and active encouragement by the Department of Health and Social Security since 1964, an increasing number of units have opened. Although the provision of psychiatric services specially designed to cater for the adolescent has gained momentum only in the past three to five years, the demands of this section of the population is underlined by Rosen et al. (1965) who showed, in an American survey of 750,000 clinic patients seen in 1962, that approximately one-quarter were aged between ten and nineteen years—a number representing 6 · 2 per thousand adolescents of the population served. Similar figures, namely, 6 · 6 per thousand (Kidd et al., 1968), were found in Aberdeen, and 5 · 6 per thousand (Henderson et al., 1967) were found in Edinburgh. Since an adolescent psychiatric service was opened in Edinburgh in 1967, there has been a continual increase in the demand for its services, as follows:

This suggests that the previous figures were an underestimate and that psychiatric disturbance amongst adolescents may be much greater than formerly estimated. Furthermore, such referrals do not indicate the demands for help that Approved Schools and children's homes have made. The authors believe that psychiatric skills are most effectively deployed in these settings if the psychiatrist acts as a consultant to the staff, rather than by assessing and treating individual children (Evans, 1963). Even so, demands have far outstripped the available supply of psychiatric time.

All chronic day-patients (n = 422), defined as patients aged 18–64 years attending a day facility of a psychiatric hospital or general hospital psychiatric unit continuously for more than a year, were identified in hospitals and units serving 56% of the Scottish population. The number of day patients was 14.8 per 100,000 of the general population, but the range between hospitals was very great—0 to 37.7 per 100,000—indicating the patchy development of such care. A typical day patient was a rather chronic middle-aged male schizophrenic, who lived on his own or with ageing parents. Most patients' accommodation was satisfactory, but the occupational activity of more than a third was inappropriate; 18% could have attended a local authority sheltered workshop if one had been available.

The County Borough of Brighton is a seaside town with a population at the 1971 census of 166,081. This population has fluctuated only slightly. In 1951, the total population was 156,486; in 1961 it was 163,159; in 1966 it was 159,510. Brighton's population contains a large percentage of elderly people; in 1966 there were 25 · 7 per cent of the population over the age of 60, and 18 · 8 per cent were over 65 years old, compared with 18 per cent over 60, and 12 per cent over 65 for England and Wales.

At the present time only two groups of drugs have an established place in the treatment of chronic schizophrenia, the phenothiazine derivatives and the rauwolfia group of alkaloids. Of these two groups the phenothiazines are in more general use, and, although not free from side-effects, are safer drugs for the long-term management of schizophrenic patients. They also have a wider range of effectiveness in the different schizophrenic syndromes. Many observers, however, have been impressed by the dramatic results obtained in a proportion of cases of long-term schizophrenia treated with the rauwolfia alkaloids and these may be effective in cases not responding to the phenothiazines (Kline, 2).

The use of fibrous wool protein as a model of the structural surface of receptors, possibly involved in the mechanism producing a model psychosis by drugs, was suggested by three lines of evidence.

First, the strong affinity (sorption) of certain basic compounds to keratins of low sulphur content as exemplified by the Gram-positiveness of epidermal (Fischer, 1953c) and nervous (Bailey, 1950) tissue.

Second, the accumulating evidence indicating the similarity in behaviour between keratins of high sulphur content (e.g. wool) and the protein component of certain cell membranes (Fischer, 1951; Fischer and Larose, l952a; idem, 1952b; Larose and Fischer, 1952; idem, l953a and 1953b).

Third, some preliminary experiments confirming the role of wool protein as a useful model to simulate some of those receptors for which certain drugs appear to compete.

In recent years there has been growing interest in the subject of circadian rhythms of various metabolic processes in manic-depressive psychosis. This has been prompted in part by the cyclic self-limiting course of the condition itself as well as by such characteristic changes in its clinical manifestation over the twenty-four-hour period as mood variation, disturbed sleep pattern with early morning wakening, and impaired appetite, which Pollitt (1965) has attributed to a primary change in hypothalamic function. Alterations in the circadian rhythms of plasma corticosteroids, urinary corticosteroid excretion (Bridges and Jones, 1966; Curtis et al., 1966; Knapp et al., 1967; McClure, 1966), salivary flow and salivary electrolyte excretion (Jenner et al., 1967; Palmai and Blackwell, 1965) have been reported.