Ataractic drugs have been the mainstay of treatment in schizophrenia for the last eight years. Since their introduction, mental hospitals, in various areas of the United States and in every country, have been able to discharge more patients than they admit. Despite this fact there remains much divergent opinion about the value of these drugs, doubt arising from inconsistent therapeutic results and the relapse rate. Also, some double-blind studies have cast some doubt upon the efficiency of these drugs. We are reporting this relatively small study because we feel that it opens an insight and possibly suggests a method of standardizing treatment in the near future.

This survey is the concluding part of an investigation of the distribution of abnormalities of the sex chromatin body in the whole of the patient population of Harperbury Hospital. The results of the survey of the male patients of the hospital have already been reported (Shapiro and Ridler, 1960).

So little consideration is given in early medical writings to sexual disorders, that it seems that these were, for many centuries, hardly regarded as the concern of the physician. There are a few exceptions. For example: Hippocrates (Airs, Waters, Places XVII-XXII) discussed the part played by constitutional and environmental factors in the causation of impotence among the Scythians. Later, Caelius Aurelianus, according to Zilboorg (1941), while expressing disgust at the debauchery which characterized Imperial Rome, seems to have recognized that sexual perversions were illnesses which, at times, were epidemic in character. Subsequently, and in particular during medieval times, problems of this nature seem to have had a moral rather than a medical connotation. Indeed it was not until towards the close of the nineteenth century that any real insight into the medico-psychological nature of sexual difficulties and deviations became apparent. This new awareness reached its peak following the investigations of Havelock Ellis, Freud, Stekel and others, and the formulation of certain psychoanalytic hypotheses.

The literature on the Ganser syndrome is reviewed, and a case history is described. A brief hospital admission is worthwhile for patients with this syndrome, but planning and persuasion are needed.

Earlier, we reported that true hallucinations may present as a conversion symptom. We here reiterate this and suggest that cultural sanction may be one factor that can lead to hallucinations being classified as true in non-psychotic psychiatric states.

One hundred and eighty nine consecutive in-patients with treatment-resistant affective disorder were administered the Renard Diagnostic Interview to determine whether the 45 with secondary affective disorder (SAD) differed from the 144 with primary affective disorder (PAD). The SAD group, including 15 subjects with bipolar disorder, had an earlier mean age of onset of depression and contained more unmarried individuals. The total secondary group could not usefully be differentiated by assessment of clinical symptoms or discriminating analysis of social and clinical variables. While the present study of a severely depressed population does not lend itself to generalisability, this combined sample does have characteristics of patients used in biological investigations. No significant inter-group discrimination was found to support a previous assumption that identification of a prior psychiatric disorder provides the most suitable mechanism for selecting a population for research in affective disorders.

The title of this paper should not be taken to imply that the Mental Health Act tribunal system is not currently effective. There has been little serious criticism of the work of the tribunals, and they appear to have become accepted as a permanent aspect of the detention of patients. Some doctors appear to regard them as an irritation that distracts from the care of patients, and civil liberties pressure groups tend to question their real effectiveness. Careful, detailed studies have also tended to be critical, pointing out many defects that require attention. Peay (1989) has done some impressive research into the work of tribunals which must form the basis of any future reform. Cavidino (1989) has done a much wider study, but underpinned by a ‘theory’ which detracts from its value for tribunal members, and its treatment of tribunals is peripheral, and therefore superficial.

An unusual and rare variant of Capgras syndrome is reported in which a patient with depressive illness became preoccupied with doubles of inanimate objects. The patient responded to antidepressant therapy.

In anorexia nervosa, amenorrhoea and endocrine disturbance make pregnancy unlikely while the patient's weight is low. Bulimics may conceive at quite a low weight, and anorexics who have regained weight may become pregnant but typically relapse following delivery (Crisp, 1980). Anorexia has also been reported following termination of pregnancy (Thomas & Harris, 1982). Cases of onset of anorexia nervosa with weight loss during pregnancy are rare in the literature, although there are isolated reports (e.g. Weinfeld et al, 1977; Strimling, 1984). Strimling described a treated anorexic who restarted dieting during pregnancy in response to weight gain before she realised that she was pregnant. We report on a schoolgirl who became pregnant at 14 years, whose anorexia began when she was 5 months pregnant and whose pregnancy was not discovered until she was in labour.

In therapy the psychiatrist is concerned to understand how the patient views himself and the significant people in his environment. It is of some importance to develop objective measures of the accuracy of the psychiatrist's understanding of the patient's world. The Repertory Grid offers a suitable technique.

There was a significant rise in the human growth hormone response to intravenous thyrotropin releasing hormone in 5 of 10 chronic schizophrenic adolescents maintained on antipsychotic agents, but in none of 10 age and sex matched control subjects. In 4 of the 5 patients with growth hormone rise there was a positive family history of schizophrenia, but such a family history was obtained in only one of the non-responding schizophrenics.

Catatonia is now accepted as a non-specific syndrome. Hysteria can very rarely be a cause. A case of hysterical catatonia developing twice in a year, and on both occasions responding to ECT, is presented. Initial diagnostic difficulties, and use of the sodium pentothal interview as a diagnostic test, are also described.

This paper describes a “double-blind” trial comparing ‘Triptafen’ tablets—each containing amitriptyline hydrochloride 25 mg. and perphenazine 2 mg.—with a matching placebo in the treatment of depressive illness.

Proteomics is the study of protein expression and function on a genome-wide scale and its application in psychiatric research is relatively new. As protein expression is the mediator of genetic vulnerabilities, it is critical that this area is explored further to increase our understanding of psychiatric disease and reveal potential new treatments.