The majority of men convicted of manslaughter by reason of diminished responsibility used to receive hospital orders, but are now receiving prison sentences. A sample of offenders convicted between 1966 and 1977 was studied to see the reasons for the change. It was found that the make-up of the offender population did not change materially over the period, nor did the willingness of judges to make hospital orders. What changed was the pattern of treatment recommendations made by the examining doctors in their court reports.

The increasing role of psychiatry in the medical curriculum in Denmark is described. The general schedule of psychiatric teaching to medical students is outlined, emphasizing some of the special features of the Danish tradition. Roughly speaking, six per cent of all curriculum time is devoted to psychiatry. Clinical psychiatry, medical psychology and human sexuality are described separately. Interesting new possibilities for psychiatry in connection with a current curriculum reform, allotting more time to clerkships, elective periods and liaison teaching are pointed out.

Somatosensory potentials (SEPs) evoked by vibrotactile finger stimulation have been reported to be the same in both hemispheres in schizophrenics, whereas they are asymmetrical in normals, with the contralateral hemisphere leading the ipsilateral (Jones and Miller, 1981). These findings were taken to indicate that the corpus callosum is nonfunctional in schizophrenics. To attempt replication of these results, vibrotactile SEPs of 6 schizophrenics and 6 normal controls were recorded with both bipolar and monopolar derivations. Assymetrical bipolar SEPs were obtained in both schizophrenics and controls; previous observations of schizophrenic-control differences were not replicated. Acceptable evidence of ipsilateral early SEPs was not obtained; the test procedure seems inappropriate for measuring callosal conduction time.

The prevalence of psychiatric disorder was determined according to alternative diagnostic criteria in a random sample of 576 women from an Edinburgh community. Whichever diagnostic system was applied, significantly higher rates of disorder were found among the working class, the unemployed and women who were divorced, widowed, separated or cohabiting; in the subgroup of women who met all these conditions, up to half were found to satisfy the diagnostic criteria. The observed prevalence estimates can be explained as the effects of each demographic factor acting independently, no interaction effects being needed. Our results are discussed in relation to the findings of others, and in terms of the statistical issues involved.

Of 156 discharged patients, the forty who succeeded in open employment had shown before they left hospital a combination of significantly less clinical disability, less abnormal behaviour, better work performance and better relationships with other people. We specify the approximate levels of these variables that were required to get and hold a job in the 1970s.

Four research diagnostic schemes are compared in one community sample. The prevalence of psychiatric disorder ranged from 8.7 per cent (ID-Catego, threshold and definite) through 13.7 per cent (RDC, probable and definite) to 20.3 per cent (Bedford, borderline and definite). The main comparison made is between the PSE/ID/Catego and SADS/RDC systems. Sixty-one per cent of cases are identified as such by both these schemes. There is poor agreement about labelling; only 56 per cent of cases of depression and 16.7 per cent of cases of anxiety are so diagnosed by both systems. A post hoc check list was used to identify Bedford cases; all bar one were found to fulfil RDC and PSE case criteria. The results are compared with those from other centres which have used the same diagnostic criteria in community studies.

This study examined by questionnaire the prevalence of binge-eating and self-induced vomiting among a sample of 369 consecutive attenders at a family planning clinic. 20.9 per cent reported current episodes of uncontrollable and excessive eating (‘binges’), 2.9 per cent currently induced vomiting as a means of weight control; and 4.9 per cent reported using laxatives. Binge-eating and self-induced vomiting were strongly associated with disturbed attitudes to food, eating, body weight and shape; and with psychiatric disturbance. Menstrual dysfunction was not associated with either body weight or binge-eating; it was however associated with psychiatric state. Applying conservative rules, 1.9 per cent appeared to fulfil diagnostic criteria for the recently described syndrome bulimia nervosa.

Each hemisphere's ability to sustain attention over extended time periods was investigated in 14 schizophrenics and 17 controls using dichotic detection tasks. Schizophrenics produced significantly higher rates of omission errors, as compared to that of commission errors. The rates of omission errors for schizophrenics fluctuated markedly, while the rates of commission errors remained fairly constant. Primarily due to the fluctuation of omission errors, the detection index decreased progressively when schizophrenics were engaged in right-ear tasks. These results suggest that schizophrenics demonstrate a deficit concerning ‘response set’, especially in the left hemisphere. It is feasible that there may be a correlation with disturbances in integration mechanisms of both hemispheres in schizophrenics.

A new suggestibility test, potentially useful in the context of police interrogation, was administered to 45 subjects who also completed the Wechsler Adult Intelligence Scale and the Eysenck Personality Questionnaire. Suggestibility was significantly related to low intelligence, poor memory recall, neuroticism and social desirability.

I took up my present appointment at St. George's Hospital Medical School in 1967 and found myself with friendly colleagues and a tradition of undergraduate teaching of psychiatry extending back to the immediate post-war period. This tradition had also been expressed in the textbook Psychological Medicine, written and revised over successive years by Guttman, Curran and Partridge, and in more recent years by Peter Storey, currently a senior colleague here. The book is hallmarked by its clarity of expression and the richness of its clinical observation, and has for long been a favourite with both undergraduates and postgraduates.

Autonomic arousal, measured by skin conductance level and response, was examined in 36 female patients with eating disorders (anorexia nervosa and bulimia nervosa) and 32 control subjects. No differences were found between the control group and anorexics who lost weight solely through dieting (restricting anorexics). Patients with a diagnosis of bulimia nervosa and anorexics with bulimic features, however, showed fewer spontaneous skin conductance responses and were faster to habituate to 85 dB tones than either controls or restricting anorexic patients. The pattern of findings supports recent views concerning the clinical subdivision of anorexia nervosa.

In nine schizophrenic patients on drug holiday, growth hormone (GH) response to apomorphine HCl 0.75 mg (APO) was compared with normal control data. Patients were tested at two month intervals for up to 14 months. Seven patients relapsed, and of these, five had exaggerated GH responses to APO at that time. Of these five, three had exaggerated GH responses to APO prior to clinical deterioration. Further work is required to determine whether this test can be a useful predictor of relapse.

As part of a survey of 1517 women aged 20–60 years, a factor analysis and validation study of the General Health Questionnaire (GHQ) was carried out. Although three clinically relevant factors could be isolated, their sensitivity was less than that of the total GHQ score, which was found to be a good measure of current psychiatric disturbance in this community sample.

Psychiatry is one of six major subjects examined in Finals, the others being medicine, surgery, obstetrics and gynaecology, paediatrics and community medicine. One of the main aims of our teaching is to help students to appreciate the importance of psychological factors in the diagnosis and treatment of all illness, and to realise that attention to a patient's psychological adjustment may be important even where physical illness is paramount.

A new series of patients with personality disorders has provided an opportunity to extend to both sexes an earlier finding that personality disordered women tend to be mixed handed. Eighty-one subjects completed Annett's handedness questionnaire. The frequency of mixed hand preference in both sexes was similar to that found in the previous study, though deviations from consistent preference were small and dependent on the method used to classify handedness. The hysterical, antisocial and explosive personality types were particularly likely to have mixed handedness. These associations were reflected in small but significant trends among several psychometric variables.

In two follow-up studies of a total of 175 patients, carried out approximately eight years after first hospitalization, men were under hospital care more often and for more prolonged periods than women, but used outpatient services less. At the end there were only small differences in clinical condition between the sexes, but social condition, as depicted by social adjustment, psychosexual situation and work adjustment, was clearly poorer in men than in women. This was perhaps a reflection of the men's poorer premorbid psychosocial development and social role. The differences between the sexes in the prognosis for schizophrenia are considered.

Visual evoked potentials (VEP) to different flash intensities were recorded at a central site (Cz) plus at homologous temporal and occipital locations in normal and unmedicated schizophrenic subjects. Schizophrenic patients showed an hemisphere asymmetry of the P100–N120 peak-trough amplitude with smaller left but larger right hemisphere amplitudes than normal. Further, two subgroups of patients were found with abnormalities lateralized to the left hemisphere. One group was found to have abnormal P100 amplitude-intensity patterns at the left temporal site while the other group showed deviant N120 amplitude-intensity patterns at the left occipital location. The clinical significance of these results can be seen in the higher nuclear schizophrenia (PSE-CATEGO) scores in the left temporal subgroup and the higher hypomania and situational anxiety scores in the left occipital group. Patients also showed slower than normal P100 and N120 peak latencies.

Eighty women taking part in a population study were subjected to a dexamethasone suppression test (DST) intended as a diagnostic aid for melancholia. The women were selected systematically from two age strata, 38 and 50 years. Fifteen subjects (19 per cent) were found to be non-suppressors. High post-dexamethasone serum Cortisol concentrations were not the result of elevated concentrations of the main Cortisol binder, transcortin. There were no differences between suppressors and non-suppressors as regards depressive symptoms, strain experience, body mass, gynaecological history, drug use, smoking, erythrocyte sedimentation rate, number of leucocytes, activity of serum aminotransferases and γ-glutamyltransferase, serum iron, bilirubin, ferritin content, serum growth hormone or serum prolactin. However, the non-suppressors reported a significantly lower (P <0.01) orgasmic capacity in a questionnaire inquiry about two weeks before the DST. The outcome of the study indicates that DST as the presently recommended procedure for out-patients has a lower specificity for melancholia than has been reported previously.

Using radioimmunoassay techniques, serum levels of depot neuroleptics, fluphenazine and flupenthixol, were estimated in two groups of chronic schizophrenic patients with, and without, tardive dyskinesia. There were high correlations between drug dose and plasma concentration. There was no significant difference in dose-related serum levels of either drug between the groups.

The hypothesis that patients with tardive dyskinesia develop the syndrome because they do not metabolise neuroleptics as efficiently as those without the syndrome was not supported by the data.

An inverse correlation between platelet monoamine oxidase activity and spontaneous eye-blink rate, a putative measure of central dopaminergic activity, was found in medication-free chronic schizophrenic patients without tardive dyskinesia (n = 20, rs = -.47, P <.025). A similar correlation was found when patients with tardive dyskinesia were included but was weaker (n = 27, rs = -.35, P <.05). Normal controls and patients with tardive dyskinesia did not demonstrate this relationship. This report confirms a previous finding of a significant platelet monoamine oxidase-blink rate correlation in chronic schizophrenic patients. Insofar as this relationship is mediated by dopamine, it suggests that dopaminergic relations are more readily demonstrated in schizophrenic subjects than normals. Moreover, tardive dyskinesia appears to obscure this dopaminergic relationship.