This study examined characteristics of 296 alcohol and/or drug abuse clients assigned to either (1) in-patient programmes, (2) out-patient programmes, or (3) a lower cost primary care alternative. Multivariate analysis indicated that clients admitted for in-patient care reported greater alcohol consumption and associated problems, fewer community supports and more severe symptoms such as depression and anxiety. They tended to be more frank about their problems while defence mechanisms were more apparent in clients admitted to out-patient and primary care programmes. In general, out-patients ahd more favourable prognostic indicators, such as higher social stability and lower level of alcoholic involvement. The differences among treatment programmes were along quantitative dimensions of problem severity. In particular, the alcohol dependence syndrome was a major discriminating dimension.

The General Health Questionnaire has had some popularity as an index of minor psychiatric morbidity and was used in the present study to ascertain the emotional state of newcomers to a practice in a new town. High scorers on the GHQ had more episodes of illness, had more severe ratings of psychological problems, and were more likely to receive a formal psychiatric diagnosis than were low scorers. A second survey one year later confirmed the variability of response to the GHQ, inherent in a ‘present state’ inventory. Doubts are expressed as to the psychiatric nature of the emotional upset measured by the GHQ.

A suicide attempt with a gun resulted in left frontal lobe damage in a 19-year-old obsessive man. While intelligence did not suffer and no frontal lobe syndrome emerged, the patient's obsessive rituals were significantly reduced

A case of probable neuroleptic malignant syndrome (NMS) complicating l-dopa withdrawal in striatonigral degeneration is described. This case suggests that the hyperthermia of NMS is due to peripheral heat production associated with severe muscular rigidity secondary to withdrawal of striatal dopamine drive, rather than being centrally mediated by the hypothalamus, which is not involved in striatonigral degeneration.

In order to try to overcome the common clinical experience of patients who do not take the drugs prescribed for them (Wilcox et al., 1965) a sustained release form of amitriptyline (Lentizol) has recently been made available. This trial was undertaken to test the efficacy of this formulation given once daily at night compared to standard amitriptyline given thrice daily.

The enquiry relates to the investigation of 30 cases of obsessive-compulsive neurosis with special reference to the phenomena of hostility and guilt as revealed through Foulds' Five Punitive Scales and the Thematic Apperception Test. Controls consisted of an equal number of subjects suffering from neurotic depression. Analysis reveals acting-out hostility and extrapunitive tendency in the experimental group. No significant difference was found in terms of guilt scores.

It is widely accepted that depression shows a tendency to run in families. This is partly due to genetic influences — and the subject has been covered in recent reviews. This article, therefore, does not aim to recapitulate the genetic evidence but rather aims to elucidate the mode of transmission, to achieve an understanding of relevant gene-environment co-actions and interactions, and to describe attempts to identify and localise major genes.

The clinical concept of the negative therapeutic reaction has been included in this series for a number of reasons. It is a concept of particular importance in the history of psychoanalysis, for it represents the clinical phenomenon chosen by Freud (1923) to illustrate the workings of an ‘unconscious sense of guilt’ and to indicate the existence of what he conceived of as a special mental agency—the superego. Moreover, it is a concept widely used in clinical psychoanalysis, although little has been written on the subject since Freud's original formulation of it. Unlike such concepts as transference (Sandler, Dare and Holder, 1970) and acting out (Sandler, Holder and Dare, 1970a) it has not been extensively applied outside clinical psychoanalysis. This may be regarded as surprising in view of the fact that it would seem to be readily capable of application without alteration to a wide variety of clinical situations.

A previous study of depressive psychosis—Gittleson (1966a) showed that depressives with obsessions attempted suicide six and a half times less often than depressives exhibiting obsession-delusion transitions (without change of content) or those without any obsessions at all. It was suggested that the essential “protective” factor against suicidal attempts was the phenomenological form of the obsession as an obsession and its persistence as such throughout the course of the depression.

Legal findings of unfitness to stand trial are returned ten times more frequently in Scotland than in England and Wales. Sixty-five patients in the State Hospital who had been found insane in bar of trial were compared with a control group of 64 offender patients. They showed a significantly greater incidence of homicidal crimes and diagnoses of psychotic disorders, 19 per cent of which later proved to be unstable. They had also been detained longer at the State Hospital. These findings are discussed and particular reference is made to the tendency for psychotic offenders to be almost automatically regarded as unfit to plead. A brief comparison is made with the situation in England, and some modifications in forensic psychiatric procedure are suggested.

In view of the previous finding that female deluded depressed patients do not respond to tricyclic antidepressants, a retrospective review of charts of thirteen male patients with primary depression accompanied by delusions was undertaken. None improved on tricyclics alone, whereas all those treated initially with neuroleptics improved. Twelve out of thirteen patients showed no improvement until neuroleptics were added to the treatment regimen. Implications for classification and treatment are discussed.

Psychotropic drug use was investigated using a two-stage survey of a random sample of persons aged 17 and over from a rural Spanish community. It was found that 6.9%, 11.8% and 25.1% of the population were consuming psychotropic, analgesic and somatic medicines respectively. Women presented a higher rate of psychotropic use than men (prevalence for women 10.7%, for men 2.6%). This female predominance was found to be significantly related to sociodemographic and medical factors. Psychotropic use was also associated with the physical health of the respondent. The coexistence of physical and mental illness generated an increase of consumption, whereas the absence of both types of illness was associated with a very low rate. The rates for physical and for mental illness alone were intermediate and were almost equal.

I write as one who has grappled with improving the classification of the psychoses, but I believe that the strategy of developing a set of descriptive concepts, and using such preliminary groupings to search for the primary causes of the ‘diseases‘ defined (genes, brain damage, social and psychological stressors, etc.) is insufficiently ambitious. Psychiatry has been too reductionist in its attitude to both the causes and the treatment of symptoms (such as delusions), placing the entire emphasis on investigating and treating the ‘underlying disease‘, not the delusional process itself. Internal medicine has often been able to unfold the whole disease process from primary causes and preconditions through disordered physiology to symptoms. In psychiatry it is also important to understand the pathogenesis of symptoms, that is, to specify the stages in the transposition of stress and cerebral pathology into the phenomena of mental illness.

A 21–year-old woman suffering from bipolar affective disorder developed systemic lupus erythematosus (SLE) with characteristic laboratory findings, 18 months after starting carbamazepine maintenance treatment. SLE receded after withdrawal of carbamazepine and treatment with anti-inflammatory drugs. Although both the spontaneous occurrence of SLE and the psychosis as a sign of CNS involvement of SLE cannot be excluded, SLE could be considered as an adverse effect of carbamazepine.

The patterns of use and related harm of solvent inhalation were investigated in a group of young people who misused toluene (n = 31) and a group misusing butane (n= 12). The two groups were similar in terms of patterns of use and solvent related harm. The toluene users were more likely to sniff only in a group setting, probably because of the long duration of intoxication. The toluene group were more approving in their attitudes towards taking other drugs.

Vigilance is required in order to detect the cardinal signs of neuroleptic malignant syndrome (NMS), especially after prolonged exposure to neuroleptics. In this case, NMS was diagnosed in a 29-year-old man, who had been on fluphenazine decanoate for over one year, coinciding with a cessation of his neuroleptic medication. Vigorous treatment, including assisted ventilation, was necessary, extending over three months. On recovery, his mental state and social functioning had undergone a sustained improvement sufficient for his release from hospital.

Payne and Hewlett (1960) found that the schizophrenics having the highest factor scores on their dimension of overinclusion were diagnosed paranoid schizophrenic. Payne (1966) has suggested that if overinclusive thinking is construed as an inability to disregard irrelevant stimulation it is conceivable that overinclusive thought-disordered schizophrenics will come to hold delusions of reference and persecution as a consequence of their giving these irrelevances personal significance. In this way the paranoid schizophrenic's thought disorder is seen as the basis of his delusional symptomatology. A number of studies have lent support to this contention (Payne, Caird and Laverty, 1964; Lloyd, 1967). On the other hand several studies have failed to find the predicted relationship between overinclusive test performance and delusional symptomatology (Hawks, 1964; Chapman and McGhie, 1962).

A case of Munchausen's syndrome was probably caused by brain damage sustained during a necessary cholecystectomy. Doctors should not be discouraged from seeking treatable disorder because of such patients' behaviour.

Most clinical and genetic evidence suggests that puerperal psychosis is closely related to bipolar affective disorder. During a linkage study of bipolar disorder we ascertained a British family in which puerperal psychosis was associated with consanguinity in three sisters. All three subjects had lifetime RDC diagnoses of bipolar I or manic disorder. An inbred brother also had bipolar I disorder. The only female member of the sibship to escape puerperal psychosis was outbred. These findings are consistent with several genetic models for bipolar disorder in this family. The most interesting possibility is a single major susceptibility locus of recessive effect. Under this assumption, the family could be used for homozygosity mapping to help localise the putative recessive locus. If other inbred families can be found in which the same putative recessive locus is operating, the power to localise the gene by homozygosity mapping would be greatly increased.

A simple and portable ultrasound system, using a transducer attached to a pair of spectacles, to measure disorders of facial movement is described and applied to the measurement of tardive dyskinesia. Product-moment coefficients of correlation for the split-half and test-retest assessments of reliability in 20 patients were 0.96 and 0.93 respectively. Concurrent validity was confirmed by assessing the consistency between ultrasound scores and time-sampled scores based on video films (Pearson r = 0.86). Serial measurements of tardive dyskinesia over five months revealed striking individual consistency.