Forty-five agoraphobic out-patients were randomly assigned to treatment with imipramine or placebo, and also to brief therapist-aided exposure or relaxation. All patients did systematic self-exposure homework and recorded this in a diary. Forty of these patients were followed-up two years later with self-ratings and ratings by interviewers blind to their treatment conditions. About two-thirds of the patients remained improved or much improved in their phobias, with no significant difference between any of the four treatment conditions. Spontaneous panics also remained improved. The absence of an imipramine effect may reflect the lack of initial dysphoria (anxiety–depression) in this sample compared with other studies where drug-effects have been found. The post-treatment superiority (evident at week 28) of patients who had therapist-aided exposure was no longer present at the two-year follow-up; the others had caught up, presumably because of their self-exposure homework.

Twenty-five out-patients with generalised anxiety or panic disorders were interviewed. A characteristic ideational component was identified, centering on the theme of personal danger and, in particular, on physical harm. A range of features of the ideational content is described. In the 12 months preceding onset 88 per cent of the patients had experienced significant stresses. For 50 per cent the onset of panic attacks was precipitated by somatic symptoms other than those of anxiety. The relationship between ideational content, stress and somatic symptoms is discussed.

Involving the spouse as a co-therapist made no significant difference to the outcome of treatment in a controlled study of 19 married patients suffering from agoraphobia who were engaged in short-term home-based behavioural treatment. Improvement continued to 6-month follow-up. The marriages of those with some marital difficulties at the start tended to improve, whether or not the spouse was involved. Poor initial marital adjustment was not related to the degree of improvement in agoraphobic symptoms.

Ratings of behaviour and family relationships were made on the basis of (a) a non-schedule standardised interview, (b) direct observation of family interaction during a meal time and (c) direct observation of mother-child interaction during free play. A number of scales met a battery of reliability and other criteria, and possible generalisation of these ratings across methods (interview versus direct observation) and settings (meal time versus free play) was assessed. For the vast majority of scales this was low. Reasons for this, together with some clinical implications, are discussed.

In a double-blind placebo controlled trial of oxypertine in the treatment of tardive dyskinesia, 33 patients with chronic schizophrenia received either oxypertine or placebo. At the end of eight weeks, the results showed that oxypertine was superior to placebo at a statistically significant level.

Eleven male chronic schizophrenics were given, serially, oral pimozide, fluphenazine, and flupenthixol; the two latter were also given intramuscularly as decanoates in oil. Oral haloperidol was given before and after each drug. Analysis of variance of steady state plasma levels of the different neuroleptics showed considerable within-individual variation in such levels, probably due to differences in absorption and metabolism and between routes of administration. The findings suggest that if a patient fails to respond to one neuroleptic, there may be good pharmacokinetic reasons for switching him to another belonging to a different group, or for giving the same neuroleptic by a different route of administration. The study also showed that previous administration of one neurololeptic may influence the steady state level of another. The various neuroleptics produced different effects on plasma prolactin levels.

The effects of inhaling a mixture of 35 per cent carbon dioxide and 65 per cent oxygen on the occurrence of panic symptoms defined by the DSM III, was investigated. Compared to a placebo (air), carbon dioxide produced more panic symptoms. If carbon dioxide inhalation was preceded by intake of a beta-blocker (60 mg propranolol), less symptoms occurred than if preceded by a placebo. The results are compared with earlier reports on the effects of lactate infusion. It is argued that panic disorders can be conceptualized as a fear of internal (panic) sensations and that inhalation of a mixture of carbon dioxide and oxygen may constitute an effective exposure treatment.

An investigation carried out on 97 patients with affective disorders and on 100 healthy control subjects, revealed that acute and chronic stress factors occurred more in the group of patients with affective disorders than among healthy control over a similar time period. The frequency of stressful life situations was the same before the first affective episode in patients with unipolar and bipolar illness. The possible participation of such factors in triggering the first phase of illness is discussed. Similar factors appeared in both types of affective disorders. Significantly more frequent among patients than in the control group were: marital and family conflicts, health problems, emotional and ambitional failures, lack of success and work overload.

Forty-four psychiatric patients were separated into four groups on the basis of presence/absence of hallucinations and reactive/process status. Reactive hallucinators were found to be singularly impaired in two aspects of cognitive processing: (1) tolerance of ambiguity; and (2) availability of alternative meanings. The perceptual errors produced by premature judgment and limited consideration of alternative meanings for misperceptions are discussed as factors predisposing to auditory hallucination.

One hundred and eighty nine consecutive in-patients with treatment-resistant affective disorder were administered the Renard Diagnostic Interview to determine whether the 45 with secondary affective disorder (SAD) differed from the 144 with primary affective disorder (PAD). The SAD group, including 15 subjects with bipolar disorder, had an earlier mean age of onset of depression and contained more unmarried individuals. The total secondary group could not usefully be differentiated by assessment of clinical symptoms or discriminating analysis of social and clinical variables. While the present study of a severely depressed population does not lend itself to generalisability, this combined sample does have characteristics of patients used in biological investigations. No significant inter-group discrimination was found to support a previous assumption that identification of a prior psychiatric disorder provides the most suitable mechanism for selecting a population for research in affective disorders.

Sixty alcoholics (40 males) were assessed for agoraphobia and social phobia, and over half the sample were rated as having either or both these disorders when last drinking. Twenty one subjects had mild phobias and eleven had severe phobias. The more severely phobic males were also found to be the most alcohol dependent and those with no phobias were least alcohol dependent but this effect was not found among the females. All phobic alcoholics reported that alcohol had helped them to cope in feared situations, and almost all had deliberately used it for this purpose.

A small sample of out-patients referred for phobias alone were also asked about their use of alcohol. The majority had found it helpful in coping with fears, although more men than women had deliberately used it for this purpose.

The perception of body shape was studied in 15 female patients with anorexia nervosa and 15 age matched controls. A lens was used which could be manipulated to cause a horizontal distortion of an image projected onto a video monitor. The patients showed a greater tendency to over- and under-estimate their present body shape than did the controls. Further, the patients' desired body shape was significantly thinner than that of controls, as was their estimation of what constitutes a normal body shape. These findings are discussed in relation to the literature and it is suggested that they may have important implications for treatment.

There is a remarkable lack of controlled investigations about the usefulness of psychotropic drugs in anorexia nervosa despite the popular use of neuroleptics in these patients. Inspired by a previous study using pimozide, a double-blind placebo-controlled cross-over study with sulpiride was carried out in 18 female anorexia nervosa inpatients. No direct effect of sulpiride has been established with regard to behavioural and attitudinal characteristics as measured by behaviour observation scales as well as by two self-report questionnaires (Eating Attitudes Test, Body Attitudes Test). Regarding daily weight gain, sulpiride was on the whole superior to placebo, especially in the first treatment period of three weeks. In the cross-over analysis, however, this effect did not reach statistical significance.

The 25-item Hopkins Symptom Checklist (HSCL–25) was used on two occasions four weeks apart to identify self-reported symptoms of anxiety and depression in patients attending a family planning service. Only 28 per cent of patients classified as anxious to start with remained so four weeks later, but 62 per cent of those with high depression scores and 74 per cent of those with high depression and high anxiety scores maintained significant levels of depression. The implications of these findings for routine screening are discussed.

Dysmorphophobia is an uncommon psychiatric syndrome characterized by a subjective feeling of ugliness or physical defect. Although appearance is within normal limits, the patient feels that this is noticeable to others. Views on the nature of this condition are illustrated by two case histories. It is proposed that dysmorphophobia is a discrete psychiatric illness. The symptoms arise in individuals with schizoid, narcissistic, or obsessional personality traits and should be distinguished from those phenomena which are secondary to morbid psychological processes.

Twenty-three chronic schizophrenic patients and 23 controls, all males between 20 and 40 years of age, were evaluated by CT scan. The lateral, third and fourth ventricles, the Sylvian fissures, and the largest sulcus from each of the frontal, parietal, and occipital lobes, were measured in order to determine whether the previously reported ventriculomegaly in schizophrenics was perhaps due to a disturbance of CSF flow or to atrophy, two common causes of ventricular enlargement. We found that in the schizophrenic group the third and fourth ventricles and both Sylvian fissures were significantly enlarged, but not the lateral ventricles or cerebral sulci. Our data suggest that these ventricular changes are not due to a disturbance of CSF flow or to cerebral atrophy. Other possible explanations are discussed.

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.

Cognitive therapy for depression is a psychological treatment designed to train patients to identify and correct the negative depressive thinking which, it has been hypothesised, contributes to the maintenance of depression. General practice patients meeting Research Diagnostic Criteria for primary major depressive disorder were randomly allocated either to continue with the treatment they would normally receive (which in the majority of cases included antidepressant medication) or to receive, in addition, sessions of cognitive therapy. At completion of treatment, patients receiving cognitive therapy were significantly less depressed than the comparison group, both on blind ratings of symptom severity made by psychiatric assessors and on a self-report measure of severity of depression. At three-month follow-up cognitive therapy patients no longer differed from patients receiving treatment-as-usual, but this was mainly as a result of continuing improvement in the comparison group.

Twenty-four hospitalised problem drinkers who were currently suffering from a phobic anxiety state served as subjects for this study. Each was given a detailed retrospective interview concerned with the development over time of both their alcohol dependence and phobic problems. The test-retest and inter-rater reliabilities of the data collected were found to be high. In accordance with previous experimental work, periods of heavy drinking and dependence upon alcohol were associated with an exacerbation of agoraphobia and social phobias. Subsequent periods of abstinence were associated with substantial improvements in these phobic anxiety states. It is suggested that both learning and psychobiological processes underly these observed relationships and that the implications of this finding for treatment of both disorders should be explored.

The growth hormone responses to clonidine (1.3 μg/kgm) and apomorphine (0.005 mg/kgm) have been measured in 8 drug free patients with endogenous depression. In these patients the growth hormone responses to clonidine were significantly smaller than to apomorphine. As these doses of clonidine and apomorphine have previously been reported to cause similar growth hormone responses in normal subjects, these findings support the hypothesis of a defect in the adrenergic but not the dopaminergic regulation of growth hormone in patients with endogenous depression.