All consultants in general psychiatry appointed in Britain between 1 October 1975 and 30 September 1978 were sent a questionnaire asking about their training and adequacy of experience before making a final decision. Over a quarter of the respondents were women, of whom a third had trained part-time. Family circumstances and availability of part-time posts were important determinants. Overseas graduates formed another quarter. For many psychiatry was not their first love but availability of posts and status were important factors in choice of career. Many consultants felt they lacked experience in the subspecialties within psychiatry.

As a physician with a special interest in respiratory disease, I have been concerned with the semantic problems of my own specialty (Scadding, 1959, 1963) and of medicine generally (Scadding, 1967, 1972, 1975, 1988), and more recently have been invited to consider how far my approach may be applicable to psychiatry (Scadding, 1980, 1982, 1990). I therefore read the essay on nosology, taxonomy and classification of the functional psychoses by Parshall & Priest with interest, and venture to make the following observations.

One major characteristic of behaviour disorder is persistent hostility towards authority. Those offenders who appear repeatedly before the Courts and are eventually diagnosed as cases of behaviour disorder, almost uniformly exhibit histories of difficulties with authority (8). Indeed, when a study was made of 87 case-notes of patients in a hospital for the mentally subnormal who were admitted as suffering from behaviour disorder, in order to discover those features of their previous histories which were common to all, it was found that every one showed a persistently troublesome relationship with authority figures (9).

Some patterns of deranged function—epilepsy, schizophrenia—have been enshrined as diseases; others, such as depersonalization, have, by and large, escaped this fetter. This is perhaps why there has been no difficulty in accepting that depersonalization, being a pattern of disordered function, can occur in conditions of very different aetiology. It is seen in temporal lobe epilepsy (12), temporal lobe migrane (22), depression (8), LSD intoxication (20), schizophrenia (1), phobic anxiety states (15), sleep deprivation (2) and the hypnagogic state. Shorvon (21) reported cases of depersonalization occurring in the apparent absence of other psychiatric disorder, and Davison (4) investigated in detail seven such cases. Finally the occurrence of depersonalization in people not attending psychiatric or neurological clinics is now well attested (13, 5, 18, 6).

The excess incidence of schizophrenia reported from Ireland may partly be due to the unusual distribution of the Irish population by maternal age at birth.

The revelation that opium-like substances are constitutional body elements is surely one of the major biological advances of the decade. The notion that the brain contains an inbuilt supply of opioid chemicals has been particularly seductive to the psychiatrist. It seems to offer a key to understanding, and therefore manipulating, the cerebral substrates for somatic pain, drug addiction and psychic discomfort. At a time when research effort in this area is increasing logarithmically, I present here a selective and personal view of certain aspects of endorphin research which have been claimed to be psychiatrically relevant. For detailed accounts of the background and breadth of endorphin research the reader is directed to other more extensive recent reviews (Kosterlitz and Hughes, 1977; Guillemin, 1978; Snyder, 1978; Watson et al, 1979; Hughes, 1979). The term endorphin will be used in the generic sense to include the specific Endorphins (such as β-Endorphin) and the enkephalins (Leu- and Met-)—see figure.

Evolutionary science can serve as the high-level organising principle for understanding psychiatry. Evolutionary concepts generate new models and ideas for future psychiatric study, research, policy and therapy. The authors accordingly make the case for the inclusion of evolutionary biology in the postgraduate education of psychiatric trainees.

Maltreatment in childhood affects mental health over the life course. New research shows that early life experiences alter the genome in a way that can be measured in peripheral blood samples decades later. These findings suggest a new strategy for exploring gene–environment interactions and open opportunities for translational epigenomic research.

The effects of biperiden and piroheptine on the serum level of zotepine were studied in 15 schizophrenic and 6 mentally retarded in-patients. Neither of these anticholinergic drugs affected the serum level of zotepine nor caused significant side-effects. In the schizophrenics the total scores on the BPRS did not change significantly with either combination of drugs.

This editorial discusses current challenges faced by educators in undergraduate psychiatry in a community setting. It explores day-to-day difficulties faced by clinical educators and also considers the changing landscape of community services and how this might have an impact on learning opportunities. We call for efforts to improve undergraduate teaching in community psychiatry.

Sodium valproate and related preparations have recently undergone regulatory review following concern about effects on the unborn child and doctors' failure to communicate risk. The issues are wider. Valproate is overused in psychiatry based on the false perception that ‘ease’ of use equates to better safety than alternatives. Valproic acid can disrupt fundamental physiological processes, the consequences of which are poorly understood and little discussed in the psychiatric literature. Valproate may be useful in a small number of patients with bipolar disorder but current prescribing patterns are unjustified. Perception needs to change.

Recently, research into the connection between vitamins and psychiatric disorder, particularly affective changes, has been in the doldrums, with the exceptions perhaps of studies of folic acid and pyridoxine. The best way for research to proceed is first to establish that the association of a vitamin deficiency with a psychiatric disorder is beyond a chance finding. Then, questions should be asked about what mental symptoms it is linked with, and what the other associations (malnutrition, drugs, physical illness, etc) are. Lastly, queries should be raised about whether the association is causal or if the mental symptoms are merely secondary to the anorexia and poor diet so common in mental illness (or whether they are linked in a vicious circle as suggested by Reynolds et al (1971)). These questions became pertinent in the mid-1960s when reliable ways of assaying B vitamins such as folic acid became more generally available. In this review, I present evidence that deficiencies of folic acid, B12, thiamine, riboflavin, pyridoxine and ascorbic acid are not infrequently found in psychiatric practice. It should be remembered, however, that some ways of assaying vitamins are liable to give a larger proportion of spurious low results than other methods (false positives), although the adoption of more reliable ways of assaying vitamins should reduce this.

Subthreshold post-traumatic stress disorder (PTSD) is more prevalent than PTSD, yet its role as a potential risk factor for PTSD is unknown. To address this gap, we analysed data from a 7-year, prospective national cohort of USA veterans. Of veterans with subthreshold PTSD at wave 1, 34.3% developed PTSD compared with 7.6% of trauma-exposed veterans without subthreshold PTSD (relative risk ratio 6.4). Among veterans with subthreshold PTSD, specific PTSD symptoms, greater age, cognitive difficulties, lower dispositional optimism and new-onset traumas predicted incident PTSD. Results suggest that preventive interventions targeting subthreshold PTSD and associated factors may help mitigate risk for PTSD in USA veterans.

The relationships between childhood experience, measured by the PBI, and adult defence mechanisms, evaluated through the DMI, were examined in 114 subjects. There were modest but significant correlations between the primitive defences of ‘turning against others' and ‘projection’ on the one hand, and a lack of parental care, as experienced by the subjects, on the other. ‘Principalisation’ (e.g. intellectualisation, isolation and rationalisation) and ‘reversal’ (e.g. negation, reaction formation, denial and repression) were positively associated with parental care. These findings account for only a small portion of the variance but show that, as with certain personality traits, actual or perceived childhood experience contributes in a recognisable fashion to the patterns of adult defences and behaviour.