Rigorously collated information on 40 members of one kindred (not previously studied) and on their spouses and cohabitees, revealed that massive multiagency support had failed fully to ascertain and prevent extensive child abuse over at least three generations. Furthermore, five other large battering families have been closely associated (by cohabitation) with this kindred.

Severe behaviour disorder (starting with hyperactivity and uncontrollability) occurred in at least three-quarters of the children, and usually progressed to adult criminality. The second most common disorder was subnormal intelligence, which crucially incapacitated the rearing abilities of young mothers who were associating with antisocial cohabitees. Seven children died in infancy. The Welfare State has done little to help the plight of surviving children in this kindred.

Normal-pressure hydrocephalus (NPH) was described in 1964 (Adams, 1965; Hakim, 1965) and defined by the symptom triad: dementia, motor disturbance, and sphincter disturbance. The original publication by Adams already contained a reference to psychiatric symptoms: depression, slowness, hallucinations, and apathy. Rice & Gendelman (1973) reported five cases, and commented on the development of both early cognitive impairment and behavioural regression, suggesting that personality factors might play a role in the appearance of latter symptoms. Trevor et al (1977) described a case suffering from psychotic depression, paranoid symptoms, inadequate affect, and self-destructive behaviour.

Over the years investigators have described psychiatrically abnormal individuals in the families of schizophrenics. These unusual persons have been given a variety of names: schizoids, schizoid psychopaths, and the condition called schizoidia or schizophrenia-spectrum illness (Kahn, 1923; Planansky, 1966). With recent developments in family and adoptive studies of schizophrenia which have indicated a genetic factor playing a causative role, the schizoid state has assumed more importance, especially in estimating the type of inheritance (Heston, 1970). Furthermore, the schizoid state is of considerable interest from a clinical standpoint since it may represent a ‘forme fruste’ of schizophrenia, and as such a study of schizoids from the point of view of the factors which may have prevented a full-blown schizophrenic process would be of great interest.

The Delusions-Symptoms-States Inventory (DSSI) was administered to 33 chronic non-paranoid schizophrenic patients resident on long-stay wards. It was found that the vast majority of cases (81 per cent) produced symptom patterns conforming to the hierarchy of classes of personal illness model, but with a radically different distribution among the classes from that in acutely ill patients. Within the model a half of the patients were allotted to the two lowest classes—Class 0 (Symptom-free) and Class 1 (Dysthymic States). When each set of items was considered separately and independently of the model, it was found that a half of the group professed to have recently experienced delusions. Affective states and depressive symptoms were reported by over a third of the patients.

The characteristics of West Indian patients admitted to a Birmingham hospital following deliberate self-poisoning were compared with those of White self-poisoners. West Indian patients were more likely to be young, female and single. They were less likely to have previously self-poisoned, have received previous psychiatric treatment, or be suffering from a personality disorder or alcoholism, but were more often followed-up by a social worker. Rates of self-poisoning for those aged under 25 were similar but for those aged over 25 were lower for West Indians than Whites.

Schizophrenia constitutes a lifelong vulnerability in relation to life stresses and the maintenance of social networks. Satisfactory quality of life – understood as subjective well-being in a lifetime perspective – is the ultimate treatment objective. This paper draws on research and clinical experience from Lofoten – the catchment area of a psychiatric out-patient clinic in Northern Norway. This work stresses the quality of life for the social network around the psychiatric patient as a consideration in its own right. The patient's coping resources and social network are regarded as a continuous professional concern.

The effects of ethyl alcohol in man may be classified into two main groups. The first, consisting of all those symptoms and signs that can be directly attributed to the action of alcohol itself, includes all the features of acute alcohol intoxication. The second group, with which this study is concerned, consists of a wide variety of conditions which do not appear to result directly from the action of alcohol and which may be regarded as secondary complications. They occur only when excess alcohol intake has occurred over a prolonged period.

Hare, Price and Slater (1971) plotted the age distribution of first admissions to hospital of patients suffering from schizophrenia and neurosis. (I.C.D. 7th Revision, Nos. 300, 303, 310–318). They found a close correspondence between the curves, and contrasted this with the deviation shown by similar age distribution curves plotted for mania, depression and personality disorder (I.C.D. 7th Revision, Nos. 301.0, 301.1, 301.2, 302, 320 and 321). Hare et al. argued from these curves that the environmental factors precipitating an attack are the same for schizophrenia as for neurosis.

There is currently a great deal of interest in whether or not circadian rhythms are capable of explaining certain psychiatric phenomena. This short review will briefly explain the concept of endogenous circadian rhythms and then go on to describe some of the attempts to relate this to psychiatry. It is not possible to give a complete discussion in the space available and interested readers are referred to two recent texts on circadian rhythms (Wever 1979, Minors and Waterhouse, 1981). The psychiatric aspects have been reviewed by Sampson and Jenner (1975).

Adult metachromatic leucodystrophy (MLD) is a rare demyelinating disease of the central nervous system caused by a genetic autosomal recessive defect and mediated through a deficiency in the enzyme arylsulphatase A (Peiffer, 1970). The initial manifestation may take the form of symptoms suggestive of schizophrenia or dementia (Sourander et al, 1962; Austin et al, 1968).

The dexamethasone suppression test (DST) was used in an in-patient crisis unit to determine whether the test could identify suicidal patients who might benefit from tricyclic antidepressants. DST results, DSM-III diagnoses, and measures of symptom levels were obtained for 72 patients admitted for a 3–5 day period; 31 were non-suppressors. Abnormal DST results were not related to DSM-III diagnosis or to scores on measures of depression and symptom levels. Only three patients met DSM-III criteria for major depression with melancholia; 26 patients had a diagnosis of alcohol or substance abuse. The poor specificity of the DST in this patient population suggests that its routine use in such patients could be highly misleading.

When Dr. Cook, who has the thankless task of organizing the papers and discussion of this meeting, told me I had let him down because I had not secured one of the most distinguished surgeons in the country, Mr. Jefferson, he put it to me that the least I could do was to fill in the gap. I was puzzled as to what to say until Prof. MacDonald gave me a clue, and instead of talking on physiology and anatomy, which, after all, you probably know better than I do, I propose to give you a few general considerations which seem to make for the defence of an operation such as this against Prof. MacDonald's criticism.

The speakers for this morning's discussion were asked to be practical, to limit themselves to giving an account of the essential uses of the EEG technique for clinical psychiatry, and to avoid, as far as possible, the theoretical and speculative aspects of the subject. No doubt the time has come for an attempt at re-appraisal. In the last 10 years EEG departments have been developed in most of the larger mental hospitals and nearly every psychiatric centre or group, be it mental hospital, out-patient department or child guidance clinic has access to an EEG department and refers patients for examination in increasing numbers.

Pregnancy, with the associated pain and danger of labour and the Puerperium, is an ordeal for any woman, more so perhaps to-day than it has ever been, because of the wide publicity given to the toll of puerperal infection and the need for ante-natal care. An experience so intimately connected with the love-life, and with social and economic difficulties also, is often a period of acute mental stress in perfectly healthy women. Still more is it a time of psychological tension in those constitutionally unstable and liable to mental breakdown, both because they are not able to withstand the strain of mental conflict, and because they are the more likely to meet with such emotional problems on account of their temperamental unbalance.

A Western psychiatrist visiting a ward, out-patient department, or sheltered workshop in China would find much that was familiar, not only in terms of clinical syndromes and medication usage but also in the paucity of resources, problems with administrative hierarchies, and lack of status accorded by medical colleagues to psychiatry. Chinese psychiatric patients able to converse with their Western counterparts would discover that they shared much of the experience in common: stigma, problems with employment, and difficulties in finding a marital partner. Patients' relatives from East and West, likewise, would be able to recite a litany of similar concerns and complaints: the need for guidance and advice in handling disturbed behaviour at home, the gossip of neighbours, and the fear of another relapse.

The majority of men convicted of manslaughter by reason of diminished responsibility used to receive hospital orders, but are now receiving prison sentences. A sample of offenders convicted between 1966 and 1977 was studied to see the reasons for the change. It was found that the make-up of the offender population did not change materially over the period, nor did the willingness of judges to make hospital orders. What changed was the pattern of treatment recommendations made by the examining doctors in their court reports.

Multiple tics appear in the population with a frequency estimated at from 1 in 1,000 child psychiatric out-patients (Lucas et al., 1967) to 1 in 12,500 out-patients (Ascher, 1948). The incidence of XYY karyotype is about 1.24 per thousand males (Nielsen and Christensen, 1974). The occurrence of multiple tics with vocalization in a patient with the XYY chromosome constitution strongly suggests that the extra chromosome promotes neurological abnormality.