A survey of 1,811 mentally handicapped males in eighteen hospitals is described. Males discovered with supernumerary Y chromosomes numbered 15, of whom 12 were 47,XYY. Some of the physical, social, psychological and psychiatric findings are described and compared with groups matched for IQ and height.

The main psychiatric findings are diminished intelligence, retardation in development of secondary sexual characteristics, and poor emotional control leading to inadequate social adaptive patterns which are described and discussed.

The social, criminal and psychiatric backgrounds of 878 male patients admitted for the first time to the three English Special Hospitals during the years 1961–1965 are examined and the implications of differences between them for research discussed. It is noted that only 35 per cent of the admission group have been discharged within a four year period. The need for long term follow-up studies is stressed.

Capgras syndrome in a patient with migraine is reported. It is difficult to establish whether this association, which has only been reported once before, had aetiological significance or was coincidental. Investigating all cases of Capgras syndrome for organic pathology by MRI is suggested.

Various authors have reported that alterations in urine volume are associated with alterations in urinary adrenaline and noradrenaline output. (Perman 1961 and Leroy and de Schaepdryver 1961. Weil-Malherbe and Ström-Olsen (1958) reported alterations in urinary adrenaline and noradrenaline excretion associated with mood changes in a group of patients with manic-depressive psychosis. In three of the patients studied, there was also during the manic phase an increased urine volume.

The present investigation was carried out in order to check on the reliability of the findings reported in a previous publication by Hamilton and Salmon (1962). In this first experiment objective assessments were made of the effects on male chronic schizophrenic patients of three activity programmes: Industrial Workshop Therapy, Occupational Therapy and a control situation in which patients did not receive any specific activity therapy. The effects of these therapeutic approaches were assessed in terms of test scores and ratings, as well as output and earnings for those patients receiving Workshop Therapy. For patients undergoing Workshop Therapy a separate assessment was made of the effects of payment by result compared with flat-rate payment, and of co-operative work compared with working as individuals. The major findings of this study were that Industrial Workshop Therapy led to greater improvement than Occupational Therapy, that the greatest changes in behaviour occurred while patients were working individually and receiving a weekly flat-rate payment, that the behavioural changes in the Workshop group continued in the second, piecework, phase of the investigation, that piecework payments did not result in greater output than flat-rate payment, and that patients working in small teams compared with patients working as individuals, both under piecework conditions, showed greater all-round improvement on the indices used to measure it.

The question of the long-stay mental hospital population has recently received a great deal of attention. Proposals, based on the statistics of mental hospital admissions and discharges over the last few years, the increasing development of day hospitals, out-patient clinics, psychiatric units attached to general hospitals, and community services for the mentally ill within the general framework of new and improved methods of treatment, have led to considerable thought as to how best to reintegrate former mental hospital patients into the community. The process of discharging long-stay patients has, of course, been continuous, but the numbers involved have been comparatively small in the past. A policy of reducing considerably the number of mental hospital beds depends partly on aiming at the highest possible maintenance capacity of discharged patients. For long-stay female patients this would involve, among other aims, the re-training in domestic skills to adequate levels, while in male patients the aim would have to be some form of industrial resettlement. The general aim of increasing the activity and skill level of long-stay mental patients has found its expression in the establishment of industrial workshops. From its early beginnings (Baker, 1956) this form of therapy has developed into the establishment of production workshops or factories both inside and outside the walls of mental hospitals. (Wadsworth, Scott and Tonge, 1958; Early, 1960; Cooper and Early, 1961; Wadsworth et al 1961, 1962.)

In recent years the introduction of neuroleptic drugs into large overcrowded mental hospitals has been accompanied by a striking improvement in their atmospheres which have become more therapeutic and less custodial (W.H.O., 42). Accordingly it has become possible, often for the first time, to organize effective programmes of rehabilitation for the chronic schizophrenics who still constitute a high proportion of mental hospital populations (Brill and Patton, 7). The new programmes have usually included group nursing, planned activities, and graded incentives for patients to strive to regain their positions in society. This approach has placed emphasis on the patient as an individual, having rights and responsibilities, safe, trustworthy, and, with assistance, often able to help himself and others (W.H.O., 41). Because of these changes in the State Hospital, it is not surprising that the literature has been flooded with enthusiastic reports and wholehearted endorsement of the merits of a variety of neuroleptic agents.

A trial was carried out over twelve months of a method for monitoring the care of a large number of schizophrenic patients in the community. The method has been demonstrated to be practical in use, economical of resources and potentially relevant to a number of chronic disorders.

In view of the structural similarity of imipramine and promazine, an attempt has been made to obtain a stronger anti-depressive effect by means of chlorination of imipramine at the same place in the molecule. Brandner (1964) has described the results of mono-chlorimipi-amine (MCI) administration in a series of 25 cases of various kinds of depression.

Persisting positive symptoms largely unresponsive to treatment (Tuma & May, 1979; Macmillan et al, 1986; May et al, 1989) occur in about 7% of patients with schizophrenia but lesser degrees of treatment resistance are common (Hogarty, 1988; Johnstone, 1990) and problems of recurrence of positive symptoms and deterioration of negative symptoms are well known (Johnstone, 1990). Schizophrenic patients have also been found to have persisting non-psychotic symptoms, particularly depression (Cheadle et al, 1978). Disorders of movement in relation to schizophrenia and their treatment have been found to be disabling in a few patients and to cause lesser problems for many (Kane et al, 1985). The assessment of the mental state and of clinical evidence of movement disorder in the patients who form the subjects of the Harrow study was therefore clearly of interest, as it is rarely possible to examine these issues in a large, unselected sample.

Finger tremor and extrapyramidal side-effects (EPSEs) were measured in seven patients before and during neuroleptic drug treatment to assess the relationship between the onset of EPSEs and changes in finger tremor spectra. Tremor and EPSEs were also measured in twelve patients stabilized on neuroleptic drugs to determine whether tremor could provide a reliable index of the presence and severity of extrapyramidal system disturbance. A downward shift in peak tremor frequency was noted within 48 hours of starting neuroleptic drug therapy, usually before the onset of EPSEs, and a significant negative relationship between the severity of EPSEs and tremor frequency (but not tremor amplitude). The peak frequency of finger tremor is thus a sensitive index of extrapyramidal disturbance and might be of value in predicting which patients taking neuroleptic drugs need anti-parkinsonian therapy.

A sample of 471 enlisted men 183 cm or taller serving in the US Navy, Coast Guard, and Marine Corps was screened for Y-chromosome aneuploidy by use of quinacrine fluorescence of peripheral blood smears. Two 47, XYY males were detected, resulting in a prevalence of .00425 or approximately 1 in 236. The prevalence of 47, XYY males (.00331) in a number of samples of tall, non-institutionalized males is significantly higher than the incidence in newborn males (.00091), indicating that 47, XYY males are disproportionately represented in tall male populations. The 47, XYY males had significantly higher scores than 46, XY males on the Schizophrenia, Schizophrenia + 1K, and Prejudice scales of the Minnesota Multiphasic Personality Inventory and significantly lower scores on the Dominance scale. Since the probability that a randomly selected pair of subjects in the sample had four or more scale scores significantly different from the remainder of the group was greater than .05, it is possible that the differences between the 47, XYY and 46, XY males occurred by chance. On the other hand, one or more of these scales may measure personality dimensions on which non-institutionalized 47, XYY males may, in fact, differ from 46, XY males.

The last decade has seen a shift in the emphasis of research into student problems and student performance. On the psychological side there has been a move away from somewhat static concepts of personality measurement and intellectual assessment, and the concomitant preoccupation with prediction and selection, towards a more interactive approach in which individual aspects are related to academic and social processes (e.g. Sanford, 1962; Lavin, 1965; Wankowski, 1969). On the mental health side there has been a shift from 'syndrome identification’ towards a more dynamic appraisal of personal and social forces and their interaction (Grant, 1969; Ryle, 1969; Lucas and Linken, (1970).

A survey of attitudes to psychosurgery among consultant psychiatrists in two regions of Britain was undertaken by a postal questionnaire. Most psychiatrists considered that there is still a role for psychosurgery in psychiatric practice and over 75 per cent of psychiatrists working in general adult psychiatry requested facilities for the referral of patients; the majority of those requesting preferred local facilities and thought that the psychosurgical team should carry out both the assessment and postoperative rehabilitation. Respondents to the questionnaire were conservative in their indications for considering psychosurgery. The effect that the revision of the Mental Health Act might have on psychosurgical practice was then considered and finally the organization of the authors' own practice is described.

Perceptual learning was examined with respect to variations in ECT electrode placement (bilateral versus right unilateral) and ECT stimulus waveform (sinusoidal versus brief-pulse). While patients receiving right unilateral ECT demonstrated more perceptual learning than did those receiving bilateral ECT, no difference in perceptual learning resulted from the variation in electrical stimulus waveform. Furthermore, the amount of perceptual learning was unaffected by EEG seizure duration and by the total amount of electrical stimulus energy delivered. The theoretical issue of whether an electrical or a seizure difference between bilateral and right unilateral ECT is responsible for inter-group learning or memory differences is discussed, as well as practical issues related to the choice of electrode placement.

Describing the occurrence of pseudocyesis and its treatment in a 15-year-old girl, Hardwick and Fitzpatrick (1981) pose the question whether there is any association between pseudocyesis and child stealing. They comment that such an association has not so far been reported. However, cases of presumed pseudocyesis have previously been noted among child stealers (d'Orbán, 1972; 1976; 1981) (based on patients' accounts which could not be verified) and three characteristic offence patterns were described:

The classification of anxiety disorders is a controversial subject, and this controversy is reflected in the differences between the systems adopted in DSM-III-R and in the draft of ICD-10. The scheme in ICD-10 is the simpler: anxiety disorders are divided into phobic disorders and other anxiety disorders, and each is divided further into three subgroups. The three phobic disorders are: agoraphobia, social phobia, and specific phobia. The three subgroups of ‘other anxiety disorders’ are panic disorder, generalised anxiety disorder, and mixed anxiety and depressive disorder. The subdivisions of phobic disorder are those now generally adopted in most countries, and are uncontroversial. The subdivisions of generalised anxiety disorder, and mixed anxiety depressive disorder are also widely accepted, the latter group being particularly frequent among patients seen in general practice and not referred on to psychiatrists. Only the category of panic disorder is controversial. In addition to these categories which are specifically allocated to anxiety disorders, two others are relevant: ‘reactions to severe stress and adjustment disorders’, and anxious personality disorder.