The literature on the drawings of schizophrenics is mainly concerned with their spontaneous artistic production. Some schools of psychotherapy use drawings systematically as an approach to the patient, i.e., as another way of obtaining free association from them. But apart from this, little work has been done on experimental drawing for diagnostic purposes. There is, however, the interesting work carried out by Mohr (1), who analysed drawings of mental patients of various kinds, and demonstrated in their production numerous clinical symptoms. His paper, classical as it is, has not stimulated many others to follow his lines. Sapas (2) collected systematically drawings of mental hospital inmates, which, in fact, were tests of visual memory. She followed, in her investigations, the technique originally proposed by Hickson in his work on The Mental Fingerprint. Lately, Becker (3) has contributed to the problems involved, in a systematic study, which will be referred to later.

Hyponatraemia and persistent urinary excretion of sodium are associated with imipramine, used to treat an elderly woman with depressive illness, which resolved on withdrawal of the drug.

One of the obvious requirements of a clinical test which purports to assess any aspect of the impairment of behaviour is that of cross-validation; it should be able to discriminate between different groups of patients similar to those on which it was first standardized. This paper reports such cross-validation of a paired-associate learning test which Inglis (1959) has shown to discriminate between groups of elderly psychiatric patients with and without memory disorder.

We examined the use of a staff-completed measure, the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), to record mental health problems in adolescents in local authority secure accommodation. It proved possible to train staff and implement completion of the HoNOSCA on 64 consecutive admissions. Interrater reliability was high. The HoNOSCA identified high levels of psychological problems on admission (mean 18.5, s.d.=5.5). Follow-up HoNOSCA ratings proved sensitive to change; however, correlation between HoNOSCA and adolescent-completed questionnaires was poor. We concluded that HoNOSCA can be helpful in documenting mental health problems among young people admitted to secure local authority units.

A patient suffering from schizophrenia developed diabetic keto-acidosis and NMS after treatment with neuroleptics. The combination of two uncommon complications of treatment with neuroleptics proved fatal.

Outcome auditing of specialist child and adolescent mental health services (CAMHS) is now well under way internationally. There is, however, debate about objectives and tools. A case is made for the achievable goal of enhancing service accountability through user satisfaction information and clinician-rated contextualised measures of improvements in symptoms and impairment.

Four schizophrenic patients are reported in whom the acute development of dystonic muscle spasms, usually involving gaze deviation, was accompanied by the exacerbation or appearance of psychotic symptoms. In all cases the relationship between the neurological and psychiatric phenomena was close, and sometimes the presentation was bizarre or dramatic. The similarity of these states to the complex neuropsychiatric disturbances seen in post-encephalitic Parkinsonism is emphasised.

The medical schools of origin of 531 psychiatrists who had qualified in the U.K. in the period 1961–1970 were ascertained. Psychiatrists were for the purpose of the study operationally defined as those who had taken the Royal College of Psychiatrists' Membership examinations since its inception. There were large discrepancies, as much as five-fold, between different medical schools, and no ready explanation is forthcoming. There were also discrepancies in the proportion of women graduates opting for psychiatry.

This study investigates whether there is any difference in the month of birth between people with schizophrenia and controls in Korea. When 1606 patients with schizophrenia were compared with 4582 age- and sex-matched controls, there was no statistically significant difference in the month of birth, the season of birth of schizophrenic patients was not related to sex, family history or handedness.

Seventy consecutive patients admitted to an alcohol unit were given a modified version of Yalom's therapeutic factor questionnaire at various points during the therapeutic programme. This programme consists of a two-week introductory programme, followed by a treatment programme, which includes psychodynamic groups, life-history reviews and intensive cognitive-therapy sessions. Internal agreement of ranking order of therapeutic factors was high among all patients and was independent of time spent in group therapy. Patients valued most an existential factor (which embraces concepts of personal responsibility and isolation), self-understanding and cohesiveness; they least valued guidance and identification. Therapists also completed the questionnaire: their ranking of therapeutic factors correlated highly with that of patients, but they ranked an existential factor much lower.

The relationship between mental disorder and social background has for many years attracted the interest of epidemiologically oriented psychiatrists. Investigations in several countries have demonstrated that patients admitted to mental hospitals are recruited to a large degree from the lower social strata of society, but there is still a vast difference of opinion in so far as interpretations of these findings are concerned.

Recent studies raise questions regarding use or abuse of alcohol by phobics, and about compatibility of behaviour therapy and benzodiazepine use. In this study 40 patients, referred with mainly anxiety-related problems to a nurse behaviour therapist, and a comparison group of 40 psychiatric nurses completed a self-administered questionnaire assessing use of alcohol, sedative drugs and tobacco, and their perceived anxiolytic effectiveness. The paper confirms earlier findings that the patients, in general, drank less than the general public. They also drank less than the nurses, but used more sedative drugs and were heavier smokers. Alcohol was an unreliable anxiolytic. A few patients, including two agoraphobics, drank heavily and did not enter treatment made conditional on stopping drinking. Implications for case management are discussed.

A cluster analysis was done on items concerned with the onset and development (including life events) of depressive illness derived from standardised interviews on 70 in-patients with that diagnosis. The resulting groups were compared for symptoms derived from the Present State Examination (PSE) and outcome, five years later. New Groupings were sought, based on onset and development data, to test their predictive power, and to observe how closely they replicated existing binary classifications and whether or not suggestions emerged for narrowing the concept of depressive illness. The groups were clinically recognisable, and measures of five-year outcome differed significantly between the groups. They have been designated as forms of ‘Somatic depression’, type I ‘Slow onset—depression of middle age’; type II ‘Rapid onset—depression of middle age’; type III ‘Slow onset — depression of younger age’; type IV ‘Rapid onset — depression of younger age, and morbid distress. It is suggested that no simple binary classification is likely to prove as satisfactory for depression as a multi-axial method; the concept of ‘morbid distress' is advanced as a way of narrowing the over-extended rubric of depressive illness.

Good results with the use of lithium salts in the premenstrual tension syndrome have been reported (Sletten and Gershon, 1966); these observations await confirmation. The value of lithium is suggested by its known capacity to affect water and electrolyte balance implicated in the pathophysiology of the syndrome, and by its efficacy in psychiatric disorders characterized by periodicity. We therefore undertook a controlled study on the efficacy of lithium in the syndrome.

The content analysis was made of special thirty minute discussions between each of 30 acute male schizophrenics and their parents to determine features of parental personality. All patients were discharged, but after 2 years 13 of them had been readmitted. Compared with those not readmitted their fathers expressed more outward-directed hostility and hostility projected on to others, and their mothers expressed more inward-directed hostility as well as guilt anxiety and shame anxiety. Both parents were emotionally more unstable during the course of the discussion. The emotional interaction between mothers and sons was of symmetrical type (whereas it was complementary between mothers and sons who had not been readmitted).

In a previous report records were studied of 256 in-patients who were discharged as undiagnosed, i.e. in-patients who at the time of discharge did not have a definable psychiatric illness (Welner, Liss, Robins and Richardson, 1972). In that study it was shown that when rigorous criteria for psychiatric research (Feighner, Robins, Guze, Woodruff, Winokur and Munoz, 1972) were used 68 per cent of these patients met the criteria for an established psychiatric disorder. It was concluded that: (1) The chart review diagnoses for a population of undiagnosed patients consisted of a variety of established psychiatric disorders and the population was not homogeneous. (The chart review diagnosis is a diagnosis obtained by review of the patients' hospital records and evaluating the information by using diagnostic criteria for psychiatric disorders.) (2) The most efficient way to arrive at a diagnosis was by structured rather than conventional narrative interview. This study is a follow-up study of these patients and attempts to evaluate the validity of the chart review diagnosis. A concordance between the chart review diagnosis and follow-up diagnosis supports the above conclusions. The follow-up study also served to establish diagnosis in patients who had too few symptoms initially to meet the criteria for a diagnosis.