The validity of judgments based upon clinical methods such as interviews or projective tests has been persistently questioned over the past 15 years. The disappointing results of clinicians' efforts to predict the professional performance of Veterans' Administration clinical psychology trainees or Menninger psychiatric residents are well-known examples (Holt and Luborsky, 1958; Kelly and Fiske, 1950). Other investigators (Glass, et al., 1956; Holtzman and Sells, 1954; Plag, 1964; Thorne, 1960) also have reached highly critical conclusions with regard to the validity of clinical procedures, based upon their studies in military settings. Eysenck (1952), in particular, has strongly rejected claims of validity for the clinical approach. Hunt (1959), after many years devoted to the problem, reports progress in achieving stable validities by application of quasi-experimental approaches to the analysis of clinical judgments. Meehl (1954), in summarizing research on the accuracy of clinical judgments more than a decade ago, suggested that such predictions often err because the clinician typically does not know what weights to give the available information nor how to combine the various cues efficiently.

Two women who both experienced a psychotic illness after each of three consecutive pregnancies are described. Subjects who are at high risk for post-partum psychotic breakdown offer an almost unique opportunity for prospective tests of hypotheses about the aetiology of severe mental illness.

Frohman et al. (1960a, 1960b, 1961, 1962) have investigated the effect of plasma of schizophrenic patients on carbohydrate metabolism. They measured the production of lactate and pyruvate by the nucleated red cells of the chicken after incubation with patients' plasma. After incubation with plasma from schizophrenic patients, the lactate/pyruvate ratio was raised significantly above the ratio found after incubation with plasma from normal subjects. This observation was interpreted as evidence of an inhibition of aerobic metabolism induced by the plasma of schizophrenic patients. We report here an attempt to confirm these findings.

Dipotassium clorazepate is a new benzodiazepine derivative with pharmacological and clinical properties resembling diazepam. This report concerns a double-blind placebo-controlled crossover comparison of clorazepate and diazepam which was carried out simultaneously at four centres in the United Kingdom.

A 12-year-old Chinese boy had a diagnosis of infantile autism at infancy that was finally confirmed as classic phenylketonuria at adolescence. This treatable inborn metabolic disease should be investigated in cases of apparent autism, especially where mass neonatal screening of inborn metabolic diseases has not been established.

Elderly patients with depression and Alzheimer-type dementia (ATD) were compared with age-matched control subjects using a protocol which measured Cortisol, adrenocorticotrophic hormone (ACTH) and N-terminal pro-opiomelanocortin (N-POMC) to determine diurnal variation and the effect of dexamethasone administration. Depressed patients had significantly elevated Cortisol concentrations both before and after dexamethasone administration. Basal ACTH and N-POMC concentrations were normal in depressed patients but were both elevated, compared with controls, after dexamethasone. By contrast, in ATD patients, Cortisol was elevated only after dexamethasone, as was ACTH, but not N-POMC. This may imply that the pattern of secretion of POMC-derived peptides underlying increased Cortisol secretion is different in ATD from that in depression.

Dependence on mephentermine, a widely used sympathomimetic pressor agent, is so far unreported, although misuse of inhalers is recognised. A case of mephentermine dependence associated with chronic psychosis is reported here. Psychosis initially surfaced with chronic dexamphetamine abuse, but was sustained for 3 years by mephentermine. After a period of remission lasting for 4 years, the patient again developed psychosis on restarting abuse of mephentermine, which lasted for 5 years.

Dramatic response of major (psychotic) depression to verapamil in an 82–year-old woman suggests that further study of the use of the drug in affective disorders is required, particularly in the light of a possible aetiological role for calcium.

British Journal of Psychiatry (1991), 158, 124–125

“Except as occasional consultants, the less men doctors have to do with female lunatics the better”. (Lowe, 1883)

“As long as women are over-represented among mental patients and family caretakers and under-represented among psychiatrists, administrators and politicians, their lives will continue to be unhappily affected by decisions in which they take no part”. (Showalter, 1987)

The aim of the study was to determine whether transsexual and homosexual males differ in their autonomic responses to erotic film sequences.

Combat reaction is a clinical entity which is classified under one of the most complex diagnostic formulations in modern psychiatry-post-traumatic stress disorder (PTSD). Of all the life experiences which may create trauma, war-related stress seems the most complicated and difficult to understand. Despite an abundance of clinical observation, this has been considered from such differing theoretical perspectives that a comprehensive therapeutic conceptualisation has proved elusive.

At the present time there is a renewal of interest in the contribution of biological factors to schizophrenic illness. This stems in part from the success of pharmacological treatment and in part from the impressive findings in studies of foster-reared relatives of schizophrenics. While the pendulum of emphasis thus seems to be generally swinging in favour of constitutional influences, recent reports on twin studies have tended to go in the opposite direction. As will be discussed below, this development is largely attributable to a methodological error in the most recent twin investigations.

Over the last 10 years I have run 17 psychotherapy groups for aged people who were in hospitals, homes or in the community. The groups were all short, usually running for 12 weeks. The total number in these groups was 121 and their ages ranged from 68 to 100. The average size of each group was seven and there were never more than four men in any group and in 11 groups there were only women. The average attendance was 88% and 36 attended more than one group. One member suffered from motor neuron disease, two from Parkinson's disease and the common causes of infirmity of old age were widely represented. All members had been diagnosed as suffering from senile dementia in two groups. In every group at least one member was hard of hearing and a communicator was used over the hearing aid to facilitate hearing. One member was blind and the sufferer from motor neuron disease continued to attend after losing her speech.

Opportunities exist for psychiatrists to spend a short term, from two weeks to four months, in underdeveloped countries under the auspices of the Inter University Council, (IUC, 1978). This is accepted as a desirable part of training and experience, as outlined in the Royal College of Psychiatrists Handbook for Inceptors and Trainees in Psychiatry (1980), and allows first-hand experience of symptom patterns and features peculiar to another culture. The present case showed a number of features characteristic of African psychiatry, including ‘brain fag’ syndrome (the syndrome which owes its name to the patient's explanation of his illness as being due to tiredness of the brain), a bizarre colourful presentation of the condition at the onset, and at one point a concern with witchcraft. Behind the illness lay family problems and significant life events which could be grasped by the outsider.

Depot neuroleptics are now commonly used for maintenance therapy of schizophrenia. Their physicochemical composition makes them ideal for such use because they are long-acting and show stable blood levels for prolonged periods. Their absorption from the site of injection may, however, be affected by local muscle factors. This paper describes three such factors in relation to fluphenazine decanoate: varying the site of injection; massage of the injection site; and effects of muscular exercise. Our results suggest that fluphenazine pharmacokinetics are not significantly affected by any of these factors.