Genetic factors have been shown to play an important role in the development of neurosis. These factors, however, determine the vulnerability of an individual, the degree of his predisposition for neurotic breakdown, while the available evidence indicates that the actual behavioural disturbance results from the imposition of some form of environmental stress on the individual concerned. The probability that any particular individual will develop a neurosis is partly determined by his genetic constitution and partly by the degree of stress to which he is subjected.

This subject should not be discussed, least of all in Scotland, without a tribute being paid to the work of Dr. Lewis Bruce, of Murthly, whose book, Studies in Clinical Psychiatry, published twenty-one years ago, is devoted to a consideration of the toxæmic causation of mental disorder.

The Social Adjustment Scale Self-report (SAS-SR) was completed by chronic schizophrenics (N = 82) living in Nithsdale, in Dumfries and Galloway region. Relatives also assessed patients' adjustment. The questionnaire response indicated that scrutiny of the form by a professional immediately after completion is necessary. Patients' and relatives' assessment of the patients' overall adjustment correlated very closely, thus suggesting a schizophrenic can satisfactorily describe his own adjustment. The patients were less well adjusted than a normal community population in all areas except the parental role. The SAS-SR highlights for each individual where many of his problems lie, and therefore may act as a guide to specific rehabilitative measures.

Conversive hallucinations are rare in the psychiatric literature. The authors present a case which demonstrates the psychogenesis and phenomenology of conversive hallucinations in a young female patient.

It is well recognized that the depressed person occasionally commits murder as a consequence of the mood disorder (Mayer-Gross, Slater and Roth, 1960). Despite the popular view to the contrary, there is much evidence that murders are rarely committed in or after epileptic seizures. Alström (1950), in a study of the frequency of criminality in 345 adult male epileptics, did not find any cases of homicide. In a 10-year period, crimes of violence were recorded for 17 per cent of the patient series and 11 per cent. of a control group. All these crimes, however, were minor, usually a complication of the abuse of alcohol. Neither severe bodily injury to others, nor a crime committed during a psychomotor seizure were encountered. He also made the important observation that, while mentally normal patients with idiopathic epilepsy had an incidence of criminality similar to that of the general population, those epileptics displaying mental disorder in addition to fits had twice this frequency of criminal records. Hill and Pond (1952) state that, from their experience in an epilepsy ward and clinic, violent or dangerous behaviour during epileptic or post-epileptic automatisms is rarely seen in any patient. Levin (1952), who studied 52 cases of epileptic clouded state admitted to the Boston Psychopathic Hospital, concurs with this view. He comments that these patients are often potentially aggressive, but their intellectual faculties are so disorganized that they are unable to carry out well-planned integrated behaviour of any kind, including aggressive acts. However, in a clinical and EEG study of 100 prisoners awaiting trial for murder, Hill and Pond, in 1952, found 18 cases of epilepsy, an incidence of epilepsy thirty-two times that of the general population. In all these cases, careful examination of the circumstances of each crime excluded the occurrence of a seizure beforehand with a high degree of probability. They concluded that a relationship exists between epilepsy and murder, although it is not directly a result of the seizure or of its immediate sequelae. In some cases, at least, the common factor may be a mental illness in the epileptic, in which the epilepsy plays an important causative role. Pathogenic factors in such cases include the disturbance of cerebral function by the seizure discharges and also the difficulties in psychosocial adjustment caused by the fits themselves or the underlying organic brain disease causing them.

Before a drug trial, researchers reasonably plan that participants will remain ignorant of which drug each patient is taking, reflected in the use of allegedly identical preparations. However, only rarely is this plan subjected to systematic scrutiny after the event, and our point of view is that this is unsatisfactory.

The case history is reported here of a woman who has developed involuntary movements while having prolonged phenothiazine therapy. The disorder has developed gradually and is apparently irreversible. It has some unusual features.

The state of an individual's mental health depends on many factors. Determination of the importance of any particular factor within a population needs access to unbiased data. We used publicly available data-sets to investigate, at a population level, how surrogates of mental health covary with light exposure. We found strong seasonal patterns of antidepressant prescriptions, which show stronger correlations with day length than levels of solar energy. Levels of depression in a population can therefore be determined by proxy indicators such as web query logs. Furthermore, these proxies for depression correlate with day length rather than solar energy.

Thirty-two agoraphobic patients were randomly allocated to four groups and treated by repeated exposure to cine-films at twice weekly intervals for three weeks. Three of the groups saw the same cine-film, comprising a range of agoraphobic scenes, and a control group saw a potter working on his wheel. The three groups seeing the phobic cine-film included one who viewed it at an illumination level below the visual threshold (subliminal group), one seeing it under normal conditions (supraliminal group) and one which underwent graduated exposure from subliminal to supraliminal viewing levels as the study proceeded (faded group). The faded group showed significantly greater improvement than the control and supraliminal groups and this improvement was maintained over twelve weeks.

A case of pericentric inversion chromosome 9 with an associated personality disorder is reported. There is justification for a more widespread cytogenetic screening of psychiatric disorders of this type.

In recent studies in alcoholism where systematic desensitization of social anxiety has been used, it would appear that there are many changes in the total behaviour of the patient, as well as the removal of the need for excessive alcohol (Kraft, 1968). This paper aims at evaluating the changes which occurred in nine patients treated in this way, as shown in a variety of psychometric tests. Although the small size of the sample limits the scope of the study, it is hoped that the information might be of use to further investigators in this field.

From time to time patients come to one who have had years of unsuccessful psychotherapy and are in desperate need of help. To undertake the treatment of such patients is to face many difficulties. Understandably they are suspicious of the new therapist; it will not do if he reminds them of the one who disillusioned them, but if they come to like or trust him they may feel that they are being disloyal to their first therapist, to whom they still have some attachment. If they notice improvement in their condition it gives them no pleasure, for they know that they have relapsed after appearing to improve in the past. On the other hand, any setback upsets them greatly; they are convinced that they will never get well, and blame either the therapist or themselves or both. They have been made to feel that analysis is the only worthwhile therapy, and that there must be something quite specially wrong with them if it cannot help them as it has helped others; so their depression and sense of failure are reinforced. Often it is not only their psychological condition but also their realistic situation that has deteriorated, sometimes beyond repair.

The question whether involutional melancholia in females can be regarded as distinct form of mental illness representing a reaction to bodily changes following the menopause has been amply discussed. It has been held by some that such a melancholia is no more than one phase of the manic-depressive psychosis (1, 2). Others hold the opposite view and justify it on statistical and clinical grounds (3).

High-quality services for people with psychosis are essential. However, in this debate David Castle questions whether separate early intervention services are the best option and argues instead for an integrated approach. Swaran Singh responds, robustly defending the value of early intervention services.

The dexamethasone suppression test was carried out on 44 children to assess agreement with diagnosis of depression. No significant association was found between suppression of plasma cortisol and depression diagnosed clinically or by cluster analysis.