Murray et al (1985) have proposed a method for using biological markers and information about family history to reduce the heterogeneity in a disease such as schizophrenia. They propose that families which are heavily loaded with illness are most likely to be segregating for a major locus and therefore should be used for studies of genetic marker or other biological traits that are thought to be related to a genetic etiology. They propose that patients without a family history (sporadics) of an illness should be investigated for hypothesised environmental components since they are the cases where environmental factors are most likely to play a large role. They give an example from their own data on Ventricular Brain Ratios (VBR) in a sample of schizophrenic twins (Reveley et al, 1984) where schizophrenic twins without any family history (FH-) of a major psychosis had significantly larger ventricles than did schizophrenic twins with a family history (FH+). They conclude that while there is a genetic determinant to ventricular size within the normal range, large ventricles reflect an environmental aetiology that is more important in sporadic cases than in those with a familial pattern to the illness. Subsequently, Reveley & Chitkara (1985) found that singleton schizophrenic patients who were FH-had a significantly larger VBR than did controls while FH+ patients had a mean midway between FH-patients and controls. While this is an attractive hypothesis for the structural brain changes seen in some schizophrenic patients, results of other studies are not consistent with these findings (Nasrallah et al, 1983; Schulsinger et al, 1984; Owens et al, 1985; DeLisi et al, 1986). For example, in our own data (DeLisi et al, 1986), ‘familial’ schizophrenics had larger ventricles than did controls and risk factors thought to be environmental (head injuries and birth complications) were found to be present in that sample.

During 1984 there were 253 admissions to the in-patient drug dependence treatment unit at Tooting Bec Hospital. Of the 198 patients responsible for these admissions, 60% were male and 43% were over the age of 30 years. There were 151 patients admitted for opiate detoxification, and 75% completed the withdrawal schedule. However, only 15 out of 25 patients admitted for benzodiazepine withdrawals were found to be physically dependent. Other reasons for admission included stabilisation of the dose of opiate (24%) and the treatment of physical complications of addiction.

A six-point predictive scale for parasuicide repetition developed by Buglass and Horton (1974a) was tested on a group of patients admitted for parasuicide to a psychiatric ward of one of the city hospitals of Verona. The scale gave a range of probability of repetition within 12 months of 15 per cent at a score of 0 up to 45.5 per cent at the scores 3, 4, 5 and 6. Moreover the scale discriminated significantly between repeaters and non-repeaters. Items significantly associated with repetition in the Italian sample, which are not represented by the six-point scale were: previous parasuicide not admitted to hospital, violence received, alcohol taken at time of act, less than one year at the present address.

Maternal age is a neglected variable, with obvious implications for aetiology, in psychiatric research. In samples of schizophrenic patients, the distributions by month of birth and maternal age at birth show remarkable anomalies. These phenomena may be connected, because the seasonal distribution of births varies with maternal age, probably as a result of the age-dependent changes of fertility. Preliminary attempts to describe the seasonal effect in schizophrenia as a function of the shift in mean maternal age are not wholly successful at the quantitative level. Southern-hemisphere findings do not seem to fit the predicted pattern. Examples from other areas of research are discussed (sudden unexpected death in infants, congenital dislocation of the hip, and handedness) in which the seasonal distributions of births, and the findings on maternal age, conform to different varieties of the expected relationship.

A detailed record of the smoking habits of 83 patients treated in hospital for neurosis was compared with national statistics derived from the General Household Survey and Statistics of Smoking in the United Kingdom, and with a control group of patients admitted for treatment of varicose veins. Neurotic patients were more likely to be smokers. They started to smoke at a younger age, smoked more cigarettes and were more likely to inhale deeply. It is concluded that neurotic patients have a greater exposure to the potentially toxic effects of cigarette smoking than non-neurotic individuals.

Four patients with severe drug resistant chronic schizophrenia all committed a dangerous act around the time of their discharge from hospital. Discharge from a long stay ward may be an important life event and might therefore be expected to be associated with some depression. Detection of depression among vulnerable schizophrenics may be important if suicide or other dangers are to be prevented.

A retrospective, multi-source screening study has detected 148 users (110 males, 38 females) of intravenous drugs who presented to all relevant agencies between 1971 and 1973 in Bristol, a city where maintenance therapy is a very infrequent practice. The peak prevalence was found in the age group 20–24 years, and it appeared that the chief sources of drugs were burglaries of chemists' shops and general practitioner prescriptions. Sixty-four per cent of our users had not been notified to the Home Office. Suggestions are made for the future monitoring and development of services.

The past decade has seen many new drugs. With use, serious side-effects have become apparent. The need for rapid assessment and advertisement of such effects led to the formation of the ‘Dunlop Committee‘.

Spence et al (2000, this issue) describe an original and incisive approach to the genetics of psychosis – an attempt to define brain connectivity in patients and family members closest to the genetic risk (‘obligate carriers’) by comparison with those remote from familial risk. Their findings are potentially important but I suggest an alternative interpretation: that words are simply less lateralised in those genetically predisposed to suffer from schizophrenic symptoms. This conclusion has, I believe, implications for understanding the organisation of the human brain.

Admissions of mentally handicapped patients over a ten-year period to a hospital group with a catchment area population of 213, 000 are described and discussed. During this time, there was a progressive increase in temporary admissions for assessment, day care, and for both planned and emergency respite care. There were also 89 admissions for permanent care associated with conditions such as psychiatric disorder, multiple handicap, and changed family circumstances.

Two patients with Gilles de la Tourette syndrome (GTS) showed tics triggered by external stimuli. This unusual feature is of significance to the aetiology of GTS and in particular the relationship between GTS and the startle response.

The aim of the present investigation is to consider the dynamics and the effects of suicidal attempts in 100 female patients admitted to Holywell Hospital in two consecutive years, 1962 and 1963. (Holywell is a psychiatric hospital of 750 beds situated in the town of Antrim, 17 miles north-west of Belfast. It serves County Antrim, which has a population of about 330,000.)

Interest in the different diagnostic groups of the mentally retarded started in the 19th century, but this made little contribution toward better treatment and care. Medical interest was mainly focused on the prevention of mental retardation. It was not until the 1950's and 60's that interest in research in the care and treatment of these persons intensified. The next step, study of the interaction between handicapped persons and the environment is the key to a better understanding of how to plan for work with the handicapped. New members of the therapeutic team (e. g., psychologists, and sociologists) will take over (Edgerton, 1984) if medical groups, especially psychiatrists, do not become more aware of the importance of the interaction between the handicapped and the environment.

We report OCD and paraphilia in two male members of triplets (the two males being monozygotic twins), and discuss the possible aetiological factors for this previously unreported occurrence. We suggest that patients presenting with paraphilia should be examined for OCD and that a detailed sexual history should be obtained in all patients with OCD.

There are only three special security hospitals in England and Wales (Broadmoor, Moss Side and Rampton). They provide an opportunity to investigate what amounts to a national sample of severe behavioural problems, with regional bias reduced to a minimum. Since the article by Tong and Mackay (1959) dealing with relationships between certain offence patterns and eventual social prognosis in terms of relapse rate, nothing has been published about the type of male patient sent to Rampton, nor about his conduct after admission. To our knowledge no similar study has ever been carried out in this country on female patients requiring special security treatment.

Thus the mind is not large enough to contain itself: but where can that part of it be which it does not contain?