Since 1804 there have been twelve case reports of patients with mood disorders showing a regular periodicity of 48 hours, eight bipolar and four unipolar. This paper describes an additional patient, a 57-year-old man with a 48-hour unipolar cycle. Although his 24-hour serum Cortisol pattern was abnormal, there were few clear-cut biological abnormalities. Possible mechanisms are discussed, and comparisons made with previous reports of similar patients.

This paper is one of two considering certain aspects of the Mental Health Act, 1959, in relation to subnormal patients; it is based on a report of a Working Party submitted to the Council of the British Psychological Society and is published with the Society's approval. (The second paper (Mittler and Castell, 1964) considers plans for hospital and community care.)

Five-hundred women electing salpingectomy for contraception and their husbands were studied by means of structured interviews and questionnaires over periods of three months to two years, beginning before surgery. The post-operative follow-up was completed for 374 couples. The subject's condition was compared before and after operation for emergence of any symptoms, and whether there was any significant difference in frequency of intercourse or other sexual behaviour, changes in sexual functioning, emotional adjustment and marital satisfaction. There was evidence of adverse psychological and sexual changes but these were apparently of a mild nature. Eighty-three per cent of the subjects complained of various symptoms, presumably of psychological origin; in 65 per cent sexual desire had declined, and 29 per cent had not resumed intercourse. The mean score of psychiatric symptoms based on clinical ratings rose from 0.38 before to 4.35 after operation, which is statistically highly significant. Paradoxically satisfaction with the operation was expressed by 92 per cent of the subjects.

Gamma glutamyl transpeptidase and mean corpuscular volume are shown to be of little value in the assessment of patients admitted to psychiatric beds for problem drinking.

Studies demonstrating the linkage to separate chromosomal locations of Alzheimer's disease, manic depression, and schizophrenia require re-evaluation of our ideas of their genetic aetiology. This article reviews the findings, and explores the increasing contribution of the ‘new genetics' to our understanding of the organic and functional psychoses.

Transsexuals are usually found to have a normal chromosome complement. The literature to data documents four transsexuals with 47,XYY pattern. This paper reports a ferule male with major cell line of 47, XYY and a gender identity disorder.

A case of an unusual pica in a patient with anorexia nervosa is described. The patient was also found to have iron-deficiency anaemia. The relationship of mineral deficiency to pica and anorexia nervosa is discussed.

It has not previously been suggested that prolactin may be involved in mental illness. Yet virtually every drug used in psychiatry either stimulates or suppresses prolactin secretion (Fluckiger, 1972). Prolactin causes renal sodium, potassium and water retention (Horrobin, 1973). It is bound to cerebral tissue and alters hypothalamic activity (Turkington and Frantz, 1972; Clemens, Gallo, Whitmoyer and Sawyer, 1971). Prolactin levels up to 100 ng./ml. potentiate the responses of smooth muscle cells to noradrenaline, while higher levels inhibit the responses: preliminary studies suggest that nerve cells behave in a similar way (Manku, Nassar and Horrobin, 1973). Emotional stress, surgery and drugs such as phenothiazines, reserpine and methyldopa can elevate human plasma prolactin levels into the 50–200 ng./ml. range (Frantz, Kleinberg and Noel, 1972; Friesen, Belanger, Guyda and Hwang, 1972).

There is increasing interest in potential harmful effects of mindfulness-based interventions. In relation to psychosis, inconsistency and shortcomings in how harm is monitored and reported are holding back our understanding. We offer eight recommendations to help build a firmer evidence base on potential harm in mindfulness for psychosis.

The question of the increase of insanity in Ireland is, of course, but a part of the much larger question, the increase of insanity generally, all the world over. But there is one peculiarity about Ireland which has been repeatedly noticed, of which, as yet, no adequate explanation has been forthcoming, namely, that while in other countries insanity has increased along with, and in a higher ratio than an increasing population, Ireland alone of all civilized countries, so far as I am aware, possesses the unique and unenviable distinction of a continuously increasing amount of insanity with a continuously decreasing population; and, what would appear to be an almost necessary consequence, the proportional rate of increase in Ireland is far beyond what exists elsewhere. The aim of this discussion then, it seems to me, should be directed not so much towards explaining such increase in insanity as Ireland shares in common with other countries, as to an endeavour, if possible, to account for the preponderance, or the assumed preponderance, of insanity in Ireland over that of other countries.

Roth and his associates (1952, 1955, 1956) making observations on the classification and prognosis of psychotic illness occurring in elderly people found that the majority of patients fell into five main diagnostic categories; about half were cases of affective psychosis, most of which responded to E.C.T., and the rest suffered from arteriosclerotic and senile psychosis, paraphrenia and delirium. All the groups, with the exception of the senile psychotics, showed a considerable proportion of physical illness, particularly the cases of affective psychosis whose first attacks occurred after the age of sixty years. Most of the cases of delirium were physically ill and of the paraphrenics 30 per cent. were either blind or deaf.

Hormone treatment for impotence and impotentia ejaculandi (delayed or absent ejaculation in the presence of normal erections and desire) (Johnson, 1965) is based on two assumptions: namely—that (1) potency in the male is androgen dependent and (2) impotency is due to relative androgen deficiency (Miller, 1968; Margolis et al., 1967; Sobotka, 1969). The synthetic preparations most frequently used are methyl testosterone, various esters, including the propionate, deconate, enanthate, etc. (Tuthill, 1955; Kupperman, 1967) and more recently a number of testosterone- ‘aphrodisiac’ combinations (Margolis et al., 1967; Cooper et al., 1971, etc.). Despite some claims of therapeutic success for the various regimes, the administration of exogenous hormones has several pharmacologic disadvantages. For instance methyl testosterone, which has to be taken sublingually or bucally, may be associated with severe toxic effects such as cholestatic jaundice, etc. (Goodman and Gilman, 1965). Parenterally administered testosterone esters, although less toxic and more certainly absorbed than methyl testosterone, have all the drawbacks of the intramuscular route; also their rate(s) of tissue release may not be optimal for metabolism. Additionally, all these synthetic compounds may inhibit endogenous testosterone formation and spermatogenesis by suppressing pituitary gonadotrophins. Long term administration may result in Leydig cell inactivity and even disuse atrophy. Recently Harkness et al. (1964, 1968) have observed that clomiphene (Fig. 1), a non-steroid triethylene derivative which in females stimulates the anovulatory ovary to secrete oestrogens (Bishop, 1970), significantly raised the levels of urinary steroid metabolites, including testosterone, in a proportion of ‘normal’ and corticosteroid deficient males. This unexpected testosterone elevating effect suggested its possible ‘experimental’ use as an alternative drug treatment in impotence. Accordingly a limited pilot study on five ‘primary’ (non-organic) impotent males was conducted: its main aims were (a) to assess the potential clinical utility of the drug and (b) to study its effects on the ‘pituitary-testes-axis' as reflected by plasma testosterone levels.

Six of eleven drug-free schizophrenic patients who were depressed following remission of their illness showed a significant decrease in their depressive symptomatology during a double-blind, placebo substitution lithium trial. Traditional indicators of prognosis did not predict lithium response in this small sample; the schizophrenic patients tolerated the lithium well. Lithium should be studied further in a larger patient sample as an adjunct in the treatment of post-psychotic depression, which frequently is treatment resistant.

A survey was made of demographic and social characteristics of patients referred to a Student Health psychiatrist over a two year period. These patients were compared with a group attending Student Health physicians. Significantly over-represented in the psychiatric group were: medical and dental students; students who had repeated an academic year; students over 30 years of age; Roman Catholic students; and students who were totally financially dependent on their parents. Findings by others suggesting that first-year and female students would be over-represented in the psychiatric group were not borne out.

Fifty-one patients with a primary major depressive disorder preceded by a stressful environmental event were compared for their response to pharmacological treatment with 75 depressives who experienced no stressful life event before illness episodes. There was no difference between the groups in treatment response rates after four and six weeks of treatment respectively.

Plasma renin activity (PRA), aldosterone (aldo) levels, electrolyte levels, and blood pressures were measured in 16 patients with affective disorders taking lithium prophylactically, and in 16 age and sex-matched control subjects. PRA and aldo levels were significantly elevated in the lithium-treated group. There was no difference between the groups in plasma electrolytes or erect and supine blood pressures, arguing against secondary aldosteronism. In the lithium-treated group, there was a significant positive correlation between both PRA and plasma aldo vs serum lithium. We postulate that lithium inhibits the action of aldosterone on the distal tubule in the kidney. Activation of the renin angiotensin system maintains normal blood pressure and plasma electrolytes.