At present the phenothiazine drugs constitute the medication of choice in the treatment of schizophrenia. While in most schizophrenics treatment with phenothiazines does ameliorate the symptoms of the disease there are a certain number of patients who remain resistant to therapy. In such patients the side effects caused by phenothiazines may also be less pronounced or completely absent.

In this paper we consider another aspect of the marriages of male neurotic patients and their wives, namely the pattern of role-playing within the marriage and the family. Though no formal predictions were made regarding the differences that might be found between the marriages of the patient and control groups, it was hoped that examination of the role-activity patterns would illuminate the data already reported in Part I and II on health, personality, time-sharing and social activity.

A 3½ month old baby boy was admitted to the children's ward with subdural and subarachnoid haemorrhages which had impaired his hearing and vision, with permanent damage to the brain. Further investigations confirmed the child as a battered baby (Generation VI No. 2 on Fig. 1., No. 12 on Fig. 2).

Over the past five years several studies have suggested that flooding and its analogues reduce fear in animals and in man. The literature on analogues of flooding in animals was surveyed by Baum (1970), who himself demonstrated that prevention of a conditioned avoidance response in rats extinguishes the response (Baum, 1966). The longer the duration of response prevention, the quicker the extinction of the avoidance response (Baum, 1969a). The greater the shock trauma involved in the original learning of the response, the longer the response prevention had to be before the avoidance response was extinguished (Baum, 1969b, 1970). In phobic human volunteers controlled studies showed that flooding in imagination reduced avoidance responses to rats (Hogan and Kirchner, 1967, 1968; Kirchner and Hogan, 1966), and that the technique worked more quickly than desensitization (Barrett, 1969) in improving snake phobias. An analogue of flooding—exposure in real life with response prevention—was also shown to be more effective than desensitization for the reduction of snake phobias (Strahley, 1965). Two studies found, however, that desensitization was superior to flooding for the reduction of snake phobias (Mealiea, 1967) and mouse phobias (Willis and Edwards, 1969), while in a further two reports flooding was not significantly different in effectiveness from desensitization for the reduction of snake phobias (de Moor, 1970) or stage fright (Calef and Maclean, 1970).

Multivariate statistical methods are being used increasingly in an effort to clarify problems in psychiatric classification. Numerous references to their application could be given, but it is sufficient here to mention recent publications by Kiloh and Garside (1963), Carney, Roth and Garside (1965) and by Kendell (1968) which have received especial attention (e.g. Eysenck, 1970), as they are concerned with the longstanding controversy about the classification of depressive illness. But there is some confusion, not least amongst the critics, about the particular roles which different multivariate techniques, notably factor analysis, can play in classification problems, and in this paper an attempt is made to clarify the situation. Almost as a trial of the reader's endurance this attempt necessitates some preliminary discussion of the psychometric concept of a ‘unitary trait’ and of the statistical rules involved in defining it. But after this problem has been disposed of attention is confined to a discussion of the main multivariate techniques in question—factor analysis, discriminant function and canonical variate analysis, and finally cluster analysis. The attitude adopted in the paper is admittedly purist, but when controversy arises, as in the case of the classification of depressive illnesses, it is well to be clear about the precise properties and purposes of the statistical models we employ if confusion is to be avoided.

Although the clinical tests of the sensorium (CTS) recommended in some standard psychiatric textbooks (Slater and Roth, 1969) are in common use, and although there have been studies using most of the constituent tests, there have been few investigations into the entire collection of tests.

The initial aim of this study was to determine the relationship between penile volume responses to female and male film sequences and sexual orientation in heterosexual and homosexual males. The second aim was to examine the relationship between aversive and appetitive conditioned responses in heterosexual males.

Anxiety neurosis has been the subject of intensive study during the past ten years. Renewed interest in this syndrome has arisen both from the stimulus of new methods of treatment and from attempts to classify anxiety more accurately. Recently Pitts and McClure (1967) reported that anxiety symptoms and anxiety attacks could be produced by a specific biochemical stimulus: sodium lactate. This work was prompted by the finding that 'standard exercise’ tends to produce an excess amount of lactic acid in patients with anxiety neurosis (Cohen and White, 1950; Jones and Mellersh, 1946; Linko, 1950; Holmgren and Strom, 1959). Pitts and McClure found that an intravenous infusion of 10 ml. of half-Molar sodium (DL) lactate per kilogram of body weight, given over a twenty minute period, produced an anxiety attack in patients suffering from anxiety neurosis. The symptoms began a minute or two after the infusion was started and developed rapidly, and some patients reported ‘exacerbations of their characteristic symptom profiles for two to five days after the sodium lactate infusion’. In their double-blind study, many fewer symptoms were produced when calcium ion was added to the lactate infusion, and almost no symptoms were produced by an infusion of glucose in saline of similar osmolarity. Many fewer and less severe symptoms were produced in normal controls than in the patient group, both in response to sodium lactate and to lactate with added calcium, and almost no symptoms during the glucose and saline infusion. Pitts and McClure postulated that anxiety symptoms may have a common determining biochemical end-mechanism, involving the complexing of ionized calcium at the surface of excitable membranes by lactate ion with resulting interference ‘with the normal functioning of calcium in transmitting nerve impulses' (Pitts, 1969). They concluded that ‘there may be something highly specific about lactate ion in producing the naturally occurring hypocalcaemic anxiety symptoms in human beings'.

Although the clinical tests of sensorium (CTS) are widely used as a quick check of mental efficiency (Slater and Roth, 1969), they have come together in a haphazard way and their validity has been questioned (Shapiro et al., 1956). For example, a patient may be able to perform well on so-called memory tests such as Digit Span and Babcock Sentence and still have a florid memory disturbance (Roth and Hopkins, 1953; Zangwill, 1946).

A conspicuous deficiency of practically all birth order studies is the absence of a general population control group. Instead, a number of statistical methods of estimating the expected number of subjects in each sibling position have been used. These are based upon the assumption that for any given size of sibship there should be equal numbers of subjects in each birth rank. As Price and Hare (1969) have pointed out, there are a number of reasons why such as assumption is incorrect, and therefore why the conclusions based upon it are unreliable. Because, in most studies, only relatively small numbers of patients are available various methods of combining sibships of different sizes are adopted and the sexes of the siblings are ignored. To consider a sibling position irrespective of the size and composition of the sibship in which it occurs is unjustifiable. As birth order effects are relatively slight, large numbers of subjects are required to detect them. Unless a patient sample of several thousand is used the numbers in any sibship size are too small to permit analysis by birth rank. As sibship size is itself a possible variable, and as within each sibship the sexes of the siblings can be distributed in a variety of ways, birth order studies should ideally consider one sibship size at a time and should investigate sibling position by sex of sibling. Unfortunately, in sibships of four or more the numbers of combinations become so great as to render this approach impracticable.

The use of 1, 4 benzodiazepine drugs in the treatment of anxiety is well known and quite popular. The range of these drugs so far in clinical use includes chlordiazepoxide (Librium), diazepam (Valium), oxazepam (Serenid D) and nitrazepam (Mogadon). All have the advantages that effect is produced rapidly, side effects are of infrequent occurrence, and there is a very high safety factor.

One of the many possible ways of obtaining information about the marital relationship is by observing the marital partners together, a procedure being increasingly used in clinical practice. Little is established, however, for either clinical or research purposes, about how such observations may be ordered, with what reliability they can be made, or how they relate to other aspects of marital function and to the psychological health of the partners. This paper is concerned with just such issues.

In 1959, West and Dally reported the effects of iproniazid in depressive syndromes, drawing attention to the greater therapeutic effectiveness of this drug in ‘atypical’ or ‘hysterical’ depressive states than in endogenous depression. Later, Sargant and Dally (1962) found a group of patients with good previous personalities, showing obvious features of depression, whose anxiety symptoms responded to phenelzine alone, but in view of the response of other patients with anxiety they questioned whether monoamine oxidase inhibitors were really antidepressant, or whether they were essentially drugs acting against anxiety. These findings prompted this study, intended to compare other parts of the clinical pictures of anxiety states responsive to monoamine oxidase inhibitors with those of depressive illnesses.

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.

In this article seven cases of frontal brain tumour, all of which were meningiomas, are reviewed and observation of their psychiatric presentation given. For various reasons frontal meningiomas are found more frequently in mental hospitals than in neurological centres (Hunter et al., 1968).

Lorazepam is a psychotropic agent of the benzodiazepine class which has an action qualitatively similar to, but more potent than, chlordiazepoxide and diazepam. In animals lorazepam is about twenty times as potent as chlordiazepoxide as an anti-anxiety agent and 10–50 times as potent as an anticonvulsant. In addition it has been reported as having an effective amnesic effect in higher doses in animals.

The Middlesex Hospital Questionnaire (M.H.Q.) is a brief self-rating inventory that is intended to cover the full clinical range of neurotic illness (Crown and Crisp, 1966). It usually takes about 7–10 minutes to complete, and a few minutes to score. Although many questionnaires attempt to measure general neurotic ill-health, the only other short test that purports to rate patients comprehensively in terms of clinical categories (e.g. anxiety state, neurotic depression, obsessional neurosis, hysteria) is Fould's Symptom-Sign Inventory, which requires verbal administration by the examiner and does not cover psychosomatic and phobic syndromes.

Comments have been frequently made on the differences in the symptomatological pattern of depression in different cultural groups. Kraepelin (1921), in his study on the incidence of depressive illness in Asian countries, mentioned that depression in Java was characterized almost exclusively by excitement and confusion and that ideas of sin and suicidal tendencies were absent. Carothers (1958) could not elicit feelings of guilt or self abasement in depression among the Africans of Kenya. Lambo (1956), of Nigeria, thought that the rarity of depression observed by many workers in African countries might be due to erroneous diagnosis, and that most of the cases remain concealed by the label of ‘neurasthenia’. Out of fifteen cases of definite affective psychosis seen by him only one showed guilt feelings, self-condemnation and anticipation of punishment. Multiple somatic features, phobic and obsessional symptoms and anxiety were common. Yap (1965), commenting on the findings of various workers about depression in African countries, states ‘there is agreement among these authors on the rarity of outspoken affective illness, lightness and short duration of depression with an absence of ideas of sin and guilt, the relative frequency of manic pictures, the common association with confusional symptoms, and a very low suicide rate.’ He also refers to Pfeiffer's findings about the frequency of hypochondriacal depression in the Chinese. The absence of delusions of sin in Chinese as well as in Japanese depressives has also been noted by Yap (1958). On the other hand, Eaton and Weil (1955), in a study concerning the Hutterites, have reported a high incidence of guilt-ridden depression.

Arson has long been a subject of interest to the psychiatrist. In the early nineteenth century, continental psychiatrists in particular maintained that pyromania was a form of insanity, and laws were enacted in the German States and in France to protect such persons from the death penalty. The underlying sexual roots of arson have been stressed (e.g. Stekel, 1924), and although Reiss (1909) suggested that it might represent any form of displaced emotional reaction to tension, and McKerracher and Dacre (1966) that it might represent displaced aggression, the view of a sexual basis for arson is still commonly held.

The Middlesex Hospital Questionnaire (M.H.Q.) is a self-rating scale designed to provide rapid quantification of common symptoms and traits relevant to the conventional clinical categories of psychoneurotic illness. The inventory comprises 48 brief questions for each of which two or three simple alternative answers are provided. By use of a standard key, the following six subtest scores are easily calculated: free-floating anxiety (FFA), phobic anxiety (PHO), somatic concomitants of anxiety (SOM), obsessional traits and symptoms (OBS), depression (DEP), and hysterical personality traits (HYS). In that the questionnaire provides an approximation to what would be expected at a clinical level from a diagnostic psychiatric interview, it has advantages over other questionnaires which incorporate essentially non-clinical constructs of personality functioning.