Thirty years ago it was suggested that the apparently higher incidence of manic-depressive illness in women might be due to X-linked heredity. The hypothesis was undermined by subsequent reports of the frequent occurrence of father to son transmission. Winokur and his associates recently revived it, providing data which indicated that such transmission is absent or rare in the bipolar form of the illness. Additional support has come from linkage studies with known genetic markers located on the X chromosome. The present study, based on the 400 parents of 100 male and 100 female bipolar manic-depressive probands, failed to discover a lack of father-son compared to other affected parent-child pairs. This finding, together with a review of the literature, would indicate that it is premature to invoke X-linked heredity as a general explanation for bipolar manic-depressive illness, though there is mounting evidence that it may account for the illness in some family pedigrees.

Learning is said to be state-dependent when a response which is learned in a given internal state shows disproportionate decrement in retention when the internal state of the learner is changed. Research on this phenomenon has a long history. It was first noted by investigators who were concerned with the problem of whether overt responses were necessary for the formation of classically conditioned responses. Curare was used to eliminate the overt response, and it was found that:

In a four-week, double-blind, clinical trial thirty-one patients with depressive neurosis were treated with viloxazine, doxepin, or placebo. There were no differences among the three groups in therapeutic effects. Many depressed out-patients improve on placebo. Viloxazine hydrochloride is one of a series of compounds developed to explore the central nervous system activity of the aryloxypropanolamine type of β-adreno-receptor antagonists. Initial clinical studies support the hypothesis that viloxazine has antidepressant properties in man (Bayliss et al, 1974; Bereen, 1973; Pichot et al, 1975; Tsegos and Ekdawi, 1974).

We report for the first time the case of a male patient with the Noonan syndrome (Turner phenotype with a normal karyotype) who also had a psychiatric disorder which satisfied research criteria for schizophrenia.

The Wechsler Adult Intelligence Scale is now rapidly replacing the Wechsler-Bellevue as the major battery used by British clinical psychologists to test intelligence or intellectual deterioration. The following investigation was conducted to ascertain divergences in British mental patients from the American order of difficulty of items in the Information, Vocabulary and Picture Completion Tests, where both obvious and subtle cultural factors are present. The equivalence of certain possible substitute items was also explored.

Antiseizure medications (ASMs) are the second most widely prescribed psychotropic for people with intellectual disabilities in England. Multiple psychotropic prescribing is prevalent in almost half of people with intellectual disabilities on ASMs. This analysis identifies limited evidence of ASM benefit in challenging behaviour management and suggests improvements needed to inform clinical practice.

Amitriptyline, 5-(3 dimethylaminopropylidine)-dibenzo (a,d) (1,4) cycloheptadicne hydrochloride, though chemically and pharmacologically related to imipramine (Barsa and Saunders, 1961) has a tranquillizing effect which is absent with imipramine (Pressman and Weiss, 1961; Bennett, 1961); it acts simultaneously as an antidepressant through its influence on the “anxiety factor” (Freed, 1960; Dorfman, 1960). In contrast to imipramine and the monoamine oxidase inhibitors, amitriptyline has very little influence on the circulatory system and blood pressure (Jensen, 1961) and less proneness to exacerbate the symptoms of schizophrenia (Barsa and Saunders, 1961). Dunlop (1961) noticed a reduction in other symptoms, such as gastrointestinal distress, hyperventilation and vasomotor dysfunction for which amitriptyline was not primarily administered. This he attributed to an anticholinergic side-effect on the central nervous system.

Speech disturbances manifest in various psychiatric conditions and demonstrate temporal variability in relation to acute and stable symptom periods. They can be externally assessed, which facilitates their potential use as an objective marker of illness stage. Continued research will have positive implications for diagnostics and long-term management in clinical settings.

I am grateful to those who have included me in the honourable company of Maudsley Lecturers. When you invite a speaker from outside psychiatry, I think you hope to find one who will speak from his own central interest and experience in a way which will illuminate your own. After some inner debate, I decided that I would try to justify that expectation, even though my experience may seem remote from yours. I hope none the less that what I have to say may have some relevance to some of the sciences on which you rely, perhaps even to your profession.

At the turn of the century Kraepelin brought together the disparate syndromes of hebephrenia, dementia paranoides, and catatonia under the rubric of dementia praecox. At the same time he crystallized the concept of manic-depressive illness as an entity discrete and separate from the former syndrome. In the years since Kraepelin's classification first came to be adopted, the definitions and descriptions of these two major disorders have undergone many changes. In an attempt to comprehend the meaning and the mechanism of the psychoses, Bleuler was drawn by the emergent theories of psychoanalysis to extend Kraepelin's clinical observations into the realm of psychology. He renamed dementia praecox the schizophrenias, thus emphasizing his idea that the splitting of associative processes was a fundamental feature of the syndrome; and he added the subcategory of simple schizophrenia. American psychiatry, dominated until recently by psychoanalytic concepts, has been influenced more by Bleulerian than Kraepelinian contributions. However, it has not restricted itself to Bleulerian notions. As Kety (1980) remarked in his Maudsley Lecture, great liberties have been taken with the syndrome of schizophrenia; the essential features have been altered, primarily by an expansion of its boundaries.

In investigations in general practice it has been invariably found that the prevalence of neurosis in women is higher than in men. Logan (1960) found that housewives without family responsibilities had the lowest patient-consulting rate for psychoneurosis, and married part-time workers with family responsibilities had the highest rate. Tonge, Cammock, Winchester and Winchester (1961) found no significant difference in prevalence rates of neurosis between housewives and employed women.

Introduction The therapeutic community method of treatment was developed by Maxwell Jones at Belmont Hospital (Jones et al., 1952; Jones, 1954; Rapoport, 1960) for the treatment of psychopathic personalities. The method has been applied to an admission unit by Wilmer (1958) and to psychopathic personalities by Craft (1965). Clark (1964) has differentiated between ‘the therapeutic community approach’, of increased activity, freedom and responsibility for all patients in the hospital, and the ‘therapeutic community proper’, the small unit with face-to-face gatherings of all members, social analysis of events, opening of communications, flattening of the authority pyramid and blurring of roles.