In 41 patients with schizophrenia, we used neuroanatomical information derived from structural imaging to identify patients with more severe illness, characterised by high symptom burden, low processing speed, high degree of illness persistence and lower social and occupational functional capacity. Cortical folding, but not thickness or volume, showed a high discriminatory ability in correctly identifying patients with more severe illness.

Perhaps more than any other conditions, allergic diseases during recent years have been the subject of studies demonstrating the interplay of mind and body. In numerous papers on asthma, migraine and urticaria the psychological aspects of these disorders have been discussed. In these conditions the emotional origin of single attacks is generally admitted, but it is still a controversial subject whether, or to what extent, asthma, migraine and urticaria can be considered as part manifestations of a general psychopathological constitution. Hay-fever, since it is a purely seasonal disease, although of clean-cut allergic origin, has so far been excluded from such studies; and yet if in allergic diseases the biological over-reaction, the allergy, is in fact correlated in some way to the mental make-up of the patient, no other disease seems more appropriate than hay-fever as a crucial test of the importance of psychosomatic relationships in allergic disorders. Consequently, with the kind permission and support of Dr. Freeman, I set out to investigate the mental make-up of a number of hay-fever patients in the Inoculation Department of St. Mary's Hospital.

Workers in psychiatric genetics are, with some notable exceptions, psychiatrists first and geneticists second. Neither their medical nor their psychiatric training equips them with an appreciation of scientific method, and their narrow specialization prevents them from keeping abreast of advances in the general field of animal genetics. As things are, this is an important source of weakness; for the general geneticist, whose science is in a much more advanced state, has accumulated facts and theories that have an immediate application in our special field. One has therefore to notice comprehensive reviews of the present position in genetics in relation to the theory of evolution which have recently been provided by Dobzhansky (1941) and Huxley (1942). In what follows the work of Huxley has chiefly been drawn upon, and it is intended to provide a brief summary of the most important of these ideas.

The following is the first of a series of communications relating to urinary excretion in cases of mental disorder with special reference to acid excretion. In this paper it is proposed only to deal with the make-up of urinary acidity and the methods for the determination of the acid characters. It is well known that respiratory regulation constitutes the first line of defence against change of body reaction, and that the kidneys afford the second protection against alteration by variations in the acid-base ratio of the urine. It is also fully established that urinary acidity is dependent on the nature of diet ingested, but it is not so well recognized that the urinary reaction is also dependent on the adequacy of the respiratory compensatory mechanism, and it would appear that those interested in dietetics and chemical effects on urinary acidity have not appreciated sufficiently the significance of the physiological influences, and those concerned with the respiratory side have been apt to disregard the influence of diet. The organism promptly defends itself against alkalinity by the excretion of bicarbonate, whether the alkalinity be due to ingested alkali or excessive exhalation of acid (CO2), and this excretion of bicarbonate appears to be independent of any particular renal threshold for bicarbonate. The response of the organism to acidity, however, is a much longer process, and in this case the kidney compensation takes the form of retention of base by ammonium base production and the retention of bicarbonate by alteration of the ratio of mono- and dibasic phosphate excreted according to the equation—

The progress of 52 chronic alcoholic habitual drunken offenders who were offered a detoxification, assessment and referral service as an alternative to penal management for their public drunkenness was compared over a year with 48 control subjects, and each group's progress in the experimental year was compared with that in the previous year. The ‘detoxification’ patients were found not to have benefited as regards their alcoholism or episodes of drunkenness, though their periods of abstinence were longer. There were significant improvements in their accommodation and self-reported quality of life, and it is likely that their physical and perhaps mental health improved.

An account is given of some of the topics discussed during a small informal weekly open group meeting of chronic schizophrenic patients, based on occasional notes compiled over eleven years. The main feature of the patients' condition as displayed was poverty—clinical, social, behavioural, material and financial—and certain features suggested an organic aetiology. Reasons are given for considering that the patients' condition was predominantly caused by schizophrenia rather than by institutionalism.

The pattern of decline of a mental hospital population over fifteen years is described. Continuing problems are commented on, particularly the presence of ‘old’ long-stay patients and the accumulation of ‘new chronic patients'. The number of beds required for each of these categories is estimated.

The dissolution of the mental hospital service by degradation is deplored, and a suggestion is made that some of the good points of the old service might be salvaged before it is too late.

It is usual to encounter, in any large mental hospital, a group of patients who are considered by the staff to be difficult. This opinion is slowly formed, but, once established and repeatedly expressed in nursing reports and medical records, it rarely alters and may have a powerful influence on the patient's career in hospital. A difficult patient may find himself deprived of privileges and moved to a “lower level” ward (9, 10, 11) and his demotion in this way can affect his relatives' attitudes towards him (17). On the other hand, patients informally classified by the staff as “good patients” may be granted certain advantages and, as Cohen put it, “if they behave okay, they move to a better billet” (5).

The medical notes of 91 women who had a psychiatric illness requiring admission within nine months of childbirth were studied. The incidence of post-partum psychosis was 3 per 1000 births, of which 66% were affective psychoses.

Depression is unfortunately a very common illness; it is extremely unpleasant for sufferers and for their relatives and friends, and is associated with a substantial morbidity and mortality. The lifetime risk of developing depression was estimated by Boyd & Weissman (1981) as between 8% and 12% for men and between 20% and 26% for women. Estimates of point-prevalence vary, but a review of published studies suggests a level of 8.4% for men and 14.8% for women. A difference in prevalence of depression between men and women, with a twofold increase in women, appears to be well established. Recent evidence suggests, however, that the incidence of depression in men is rather more common than was previously thought: some apparent sex differences in frequency may be accounted for by a difference in coping with, and expression of, depressive symptoms (Angst & Dobler-Mikola, 1984). What is clear from the epidemiological studies in ‘normal’ populations is that much depressive illness remains untreated.

All existing treatments for depression, in particular the tricyclic antidepressants (TCAs), have drawbacks. Since the TCAs, for example, are associated with rather unpleasant and sometimes dangerous side-effects, which reduce compliance and compromise treatment, the search for new antidepressants with less unwanted effects and if possible greater efficacy remains an important goal. A recent trend in antidepressant research has been to develop compounds with specific pharmacological actions, which are selective for one of the amine systems. Currently, a number of specific 5-HT reuptake inhibitors are being developed, and some of these are now in clinical use.

There is no uniformity in the use of the terms habituation, addiction, intense desire, and craving. V. Petran (19) talks of craving as the irresistible desire to acquire a drug and the impossibility of abstaining from it. Craving may be manifested immediately after first consumption, but addiction represents a regular use, from which craving may develop in time.

A 20 year follow-up on 133 alcoholics was carried out. Tracing methods are outlined and the difficulties reviewed. A questionnaire was completed by 40 subjects concerning drinking outcome, aids to recovery and morbidity. Mortality data are outlined and discussed for the 53 subjects who died during the follow-up period.

The outcome of 30 new psychiatric outpatient consultations at which the psychiatrist decided to see the patient once only was examined after 3 months. Patients were referred from general practice, and evaluation was primarily from the viewpoint of practitioners; the majority were satisfied with a single consultation. However, only about half the patients were seen again by their GPs within the 3-month period, and most of the treatments recommended by the psychiatrists were not carried out by the GPs. Suggestions are offered to ameliorate this disturbing state of affairs.

Antisocial psychopaths are a community problem, not only to themselves but to their family doctors, social workers, and others who become involved in their affairs and their treatment. This article compares two attempts to provide an area service for males with psychopathic traits, the first in England and the second in Wales.