A sociological study of hospital-treated psychiatric disorder, designed to discover what social groups make use of a particular service, and for what reasons, adds another dimension to the understanding of clinician and administrator. Such a study must also reflect the changes in mental hospital practice which have followed the Mental Health Acts of 1959 and (Scotland) 1960, and the effect of these changes on individual attitudes towards in-patient care. The recent opening in Edinburgh of a completely new psychiatric admission hospital provided appropriate stimulus and setting for the present inquiry.

Twenty patients with the diagnosis hysterical personality disorder were compared with a matched control group of patients with other personality and neurotic diagnoses. Subjects' moods were assessed with a visual analogue scale 4 times a day for 5 consecutive days. Patients with a primary discharge diagnosis of hysterical personality disorder showed greater variability of mood than controls. Since emotional lability is said to be a characteristic hysterical trait, the results are taken as empirical support for the validity of one of the clinical judgements inherent in the diagnostic process.

Previous studies have shown varying rates of discrepancy in drug administration in psychiatric hospitals, and the present survey attempted to elucidate this problem further, using two methods of investigation simultaneously.

Two wards in a psychiatric hospital and one ward in a mental subnormality hospital were studied. Urine specimens were tested for psychotropic drugs, and ward drug rounds were observed to detect discrepancies in administration.

Of the 266 instances of drug administration tested for in urine specimens, prescribed drugs were not detected in 7·9 per cent of cases and non-prescribed drugs were found in another 29 instances. Observation was made of 3,689 instances of drug administration, and in 1·7 per cent of these the drug was not given or taken as prescribed, whereas no instances of ingestion of non-prescribed drugs were observed. The reasons for the discrepancies and the different results obtained by the two methods are discussed.

The reprinting by the Institute of Psychiatry, on its fiftieth anniversary, of Dr. Peter Scott's paper (1) describing Maudsley's work as a pioneer in criminology reminds us of the prominent part Maudsley played in the debate between psychiatrists and lawyers which has been in progress for nearly a century and a half, with, for much of that time, little satisfaction for either side. It is a classic example of the difficulties of inter-disciplinary communication. My only qualification to be the Maudsley Lecturer is that I happen to be doubly qualified in law and medicine, and, as Chairman of the Institute, a good deal closer to psychiatry than most lawyers. My qualities as an interpreter must therefore make good the intellectual deficiencies of which a glance at the list of my forty-seven distinguished predecessors makes me acutely conscious.

It is known that the development of maternal feelings for a newborn baby is often delayed or may not occur at all (Robson & Moss, 1970); something is also known about the psychopathology of the mother-baby relationship (Margison, 1982) but little has been written about the natural history and treatment of child rejection. The case reported here demonstrates that long-lasting rejection can be successfully treated.

In a recent series of investigations significant but conflicting relationships have been claimed between the two personality dimensions extraversion (E) and neuroticism (N) and certain spontaneous and induced features of the normal EEG. Savage (1964), using alpha abundance data from automatic frequency analysis, demonstrated a significant positive correlation between extraversion and high alpha amplitude. Extraversion has been similarly related to the amplitude of the averaged evoked potential waveform (Shagass and Schwartz, 1965). However, in an investigation by Broadhurst and Glass (1969) both alpha amplitude and prevalence bore an inverse relationship to E scores; extraversion was significantly associated with the rate of change of potential of the EEG, as was neuroticism with the alpha frequency. More recently, Winter et al. (1971) could find no direct relationship between extraversion and EEG amplitude, though there was a tendency for low amplitude activity to be associated with high neuroticism scores. The findings were interpreted as showing a significant interaction between the variables measured, the relationship of extraversion and amplitude varying according to the neuroticism score.

Phenylketonuria is an inborn metabolic disorder affecting the body's ability to hydroxylate phenylalanine to tyrosine.

Its incidence in the general population has been estimated at 0.004 per cent. and its institutional frequency at approximately 0.2 to 0.9 per cent.

To estimate the radical change that has come over medicine since the turn of the century it is worth considering for a moment the recently republished classical writings of J. Hughlings Jackson on Epilepsy and Epileptiform Convulsions. (1) Extensive and detailed as they are, they contain no hint of a possible psychological approach either to etiology or therapy. Both indeed are specifically rejected, the author taking the greatest pains throughout to keep psychology at a distance, as if it had no place in medicine proper. For instance, he describes most minutely the many and varied mental symptoms associated with epileptic attacks—both those before and those after the attack, when his acute clinical sense often takes him a long way; in his description and discussion of the “intellectual aura” and the “dreamy states” he would seem to be close to some modern views and discoveries. But for him such symptoms are only aids to diagnosis, mere pointers to underlying structural damage of the central nervous system, which is his only concern—viz. “Admitting that all mental states have parallel physical states I think our direct concern as … physicians is with the latter only” (vol. 1, p. 169). He comes to the conclusion that the study of epilepsy with a “psychological habit of mind” is “unfruitful.”

Public controversy surrounds the workings of the Abortion Act and will no doubt continue to do so, probably until such time as surgical operation is replaced by other methods. Recently the report has been published of the enquiry by the Royal College of Obstetricians and Gynaecologists which emphasises the difficulties involved in interpretation of the Act and the variations encountered in practice. There is a substantial body of psychiatric literature on the subject, e.g., Ekblad, 1955; Arkle, 1957; Kummer, 1963; Sim, 1963; Höök, 1963; Baird, 1967; Clark et al., 1968 and Kenyon, 1969, but results obtained in other countries and in this country some years ago are not necessarily applicable to this country now, since changes in public attitudes are likely to influence them. Little has been published by psychiatrists about their experience with cases since the Act came into operation. The recent follow-up series of Pare and Raven deals with cases seen in the years 1962 to 1968, i.e., mainly before the implementation of the Act.

Present drug treatments for the more common types of dementia are largely palliative or symptomatic, but the promise of drugs to prevent the development of dementia does not seem unrealistic. Neuropharmacological strategies that aim to improve behavioural or cognitive symptoms in dementia are subdivided into drugs that modify central cholinergic, serotonergic, dopaminergic, GABAnergic, and peptidergic transmission. There are no clear clinical guidelines for the management of demented patients who are also hypertensive. The early identification of patients with incipient dementia, the detection of slight but theoretically important beneficial effects, the optimum method of drug administration, more soundly based treatment of behavioural symptoms, and the evaluation of drug combinations are all identified as areas requiring further research.

A syndrome is described in three elderly women who all suffered from cerebral arteriosclerosis, and who in their dependent condition were looked after by their daughters. These women accepted their daughters as their daughters when carrying out directly caring tasks related to them, but spoke of them and addressed them as different women, with the same forenames as their daughters, when their daughters were engaged in other duties. This syndrome is compared with the syndromes of Capgras and similar conditions. It is likely to be detected with increasing frequency as psychiatrists become involved in the community aspects of the speciality.

A case of de Cléambault syndrome, secondary to paranoid schizophrenia, in a Saudi woman is documented. Cultural factors were found ineffective in modifying or preventing symptoms. Erotomania appeared to arise from the same dynamics as those of the Western patients and to follow the same pattern.

The symptoms of obsessive–compulsive disorder (OCD) are suggestive of cognitive rigidity, and previous work identified impaired flexible responding on set-shifting tasks in such patients. The basal ganglia are central to habit learning and are thought to be abnormal in OCD, contributing to inflexible, rigid habitual patterns of behaviour. Here, we demonstrate that increased cognitive inflexibility, indexed by poor performance on the set-shifting task, correlated with putamen morphology, and that patients and their asymptomatic relatives had common curvature abnormalities within this same structure. The association between the structure of the putamen and the extradimensional errors was found to be significantly familial in OCD proband–relative pairs. The data implicate changes in basal ganglia structure linked to cognitive inflexibility as a familial marker of OCD. This may reflect a predisposing heightened propensity toward habitual response patterns and deficits in goal-directed planning.