Forty-six users of the hallucinogen lysergic acid diethylamide were compared with 31 controls on a test of colour discrimination an average of two years after their last exposure to the drug. Controls performed better than users, and LSD users without flashbacks performed better than users with flashbacks. An analysis of variance between the three groups was significant at P <0.001. This study suggests that some users of LSD may have a sustained or irreversible impairment in colour discrimination.

The Visual Analogue Mood Scale (VAMS) was completed for 30 consecutive days by 124 psychiatric patients and 36 non-patient control subjects. The 65 euthymic manic-depressive patients on chronic lithium therapy had similar mean mood ratings to the non-patient controls, but had lower mood variability as measured either by standard deviation of the mood rating or by a measure of the mean successive differences between consecutive mood ratings (delta squared). This unusual mood stability appears to be an effect of lithium therapy. This study thus offers some empirical support for the ‘mood stabilizer’ psychological model of lithium's effects in patients. It is also noted that this effect may be perceived in well patients as an undesirable effect of lithium treatment.

The terminology of sexual dysfunction is ugly enough in all conscience—erectile impotence, orgasmic dysfunction and so on—but it has served a useful purpose by bringing these problems into clear focus rather than burying them within the general vagueness of terms such as impotence and frigidity.

Since Helmchen and Hippius (1967) noted that half a sample of 120 schizophrenics had depressive symptoms at the time of admission, more than 30 papers have appeared associating depressive symptoms in schizophrenics with neuroleptic medication (Ananth and Chadirian, 1980). Many authors and clinicians in fact think that a causal relationship has been proven, and the term ‘pharmacogenic depression’ and the associated concept ‘akinetic depression’ have come into use. The assumptions underlying these concepts and the evidence to support them need critical examination. They will be considered with the results of more recent studies which answer some of the outstanding questions, but in turn raise new ones about the relationship of schizophrenia and depression to their underlying pathophysiology.

The last 15 years or so have witnessed a marked growth of interest in sexual problems paralleled by a growth of interest in marital and familial processes. The pioneering work of Masters and Johnson (Masters and Johnson, 1966 and 1970) has been a focus for this trend, but the increased interest shown in professional circles is in part a response to demands created by changes within society as a whole. In particular sexual attitudes have changed as have expectations of personal happiness, and these permissive attitudes have their casualties as well as being liberating in effect.

Month of admission data to psychiatric facilities in New South Wales, 1971–76, were examined for some 23, 000 patients with a depressive disorder to determine if seasonal variations in admissions, described in the northern hemisphere, exist there. In addition, data were examined on month of occurrence of some 3, 000 deaths due to suicide and self-inflicted injury, over the same period. Seasonality was demonstrated for three ‘psychotic’ depressive disorders, but not found for neurotic depression, further supporting the binary view of depression. A peak incidence in spring was found for MDP-mania and reactive depressive psychosis, while the peak incidence for MDP-depression was was in late winter. It is suggested that the increase in certain affective disorders around spring may follow a rapid increase in luminance, and in stimulation of the pineal gland. Suicidal deaths of males did not show significant seasonality, while those of females showed two incidence peaks, the significant one occurring in spring.

Platelet monoamine oxidase (MAO) activity was studied in 33 in-patients with bipolar and schizoaffective disorder who were treated with lithium. Platelet MAO activity was found to increase following 10–41 days of lithium treatment compared to a prior drug free period, and the increase was positively correlated with the duration of lithium treatment. The increase in platelet MAO activity was not correlated with clinical improvement as measured by the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment Scale (GAS). The number of platelets per unit of blood was also significantly correlated with the number of days of lithium treatment. However, the increase in the number of platelets in lithium-treated patients was not correlated with the increase in MAO activity and thus appears not to account for it. These results indicate that studies relating platelet MAO activity to psychiatric diagnosis should be interpreted cautiously if patients are receiving lithium carbonate.

Kurt Schneider asserted that certain symptoms which he termed ‘first-rank’ invariably distinguished between schizophrenia and manic-depressive psychosis. This assertion, which has attracted considerable critical attention during the past ten years, will be examined in the light of these recent investigations.

A handedness test, administered to 88 manic male patients and 86 male control subjects, showed no difference between the two groups. The results suggest that unlike schizophrenia, mania is not associated with increased left and/or mixed-handedness.

The pattern and severity of alcohol withdrawal in 49 alcohol dependent subjects admitted to the Manchester Detoxification Centre are described. Assessment over 10 days involved the use of the Selected Severity Assessment Scale (SSA) and allocation of patients to subgroups of the alcohol withdrawal syndrome. There were associations between tremor, clouding of sensorium, hallucinations and convulsions (items of the SSA) and the four pre-delirious clinical sub-groups identified. We concluded that clinical assessment of the pre-delirious stage took into account these four variables and that there was little value in the routine use of the SSA on a unit such as ours.

There has been an exponential growth in family therapy literature in recent years. An outpouring of new books and journals have deluged the market which is bewildering to new readers. Fortunately, there are now some excellent introductory texts which help orientate the newcomer, such as Walrond-Skinner (1976), Skynner (1976) and Glick and Kessler (1980). For those who like encyclopaedic coverage there is also a recently published excellent and critical handbook edited by Gurman and Kniskern (1981). However, to gain a deeper understanding of the way the field has developed, I would like to focus on a number of texts and papers which have helped me in my own understanding over the years.

Modern psychodynamic formulations concerning the sexual dysfunctions stem directly from Freud's Three Essays on Sexuality (1905). Amplification and modification of psychoanalytical views since then have provided a further store of observation and clinical theory of personality development and the working of the unconscious mind, from which both behaviourally-, as well as psychoanalytically-orientated workers continue to draw. However, no single unified psychoanalytic theory of sexual dysfunction exists, nor should it at this stage of our understanding. Psychoanalysis continues to be the major source of psycho-dynamic principles in this field; there are three avenues down which progress is being made. The first, which forms the body of this contribution, is the application of psychoanalysis to the psychotherapeutic treatment of sexual dysfunctions. The second is the amalgamation of certain of the techniques and principles of psychoanalysis together with active behavioural practices based on the discoveries of Masters and Johnson and the behavioural therapists. [Singer (1974) in the USA; Robinson and Creed (1980) in the UK]. The third, no less interesting from a psychodynamic point of view is the way in which some modern behavioural learning theory psychologists are finding themselves facing psychodynamic complexities, such as transference, counter-transference, and a growing reliance on talking rather than manipulative procedures. Some behavioural sex-therapists see themselves as psychotherapists (Mackay, 1976). A knowledge of psychodynamics is therefore invaluable whatever one's final clinical approach.

The possible effects of clinical depression on intellectual function were investigated in unipolar and bipolar patients. Ninety-six hospitalized depressed patients completed the Wechsler Adult Intelligence Scale (WAIS) on admission and 34 were retested on remission. The high average full scale IQs found remained relatively stable throughout, consistent with earlier studies indicating a limited relationship between intellectual function and clinical severity of depression. No evidence was found for retarded psychomotor activity in bipolar groups or increased psychomotor activity in unipolar groups on three WAIS subtests of psychomotor function, but full scale IQ increased slightly in hypomania.

A distinction is made (British Medical Journal, 1978; Munro, 1980) between an excessive preoccupation with minor bodily defect, dysmorphophobia, and monosymptomatic psychosis in which a delusion of bodily change may be the sole symptom of an underlying schizophrenic or depressive illness. Hay (1981) has argued for careful distinction between the over-valued idea of dysmorphophobia and the delusion of depressive or schizophrenic illness. But in the absence of any features suggesting psychosis, scrutiny of the abnormal belief in isolation may fail to detect which sort it is. Riding and Munro (1975) hold the distinction to depend upon assessment of the abnormal belief as being of ‘neurotic’ versus ‘delusional’ intensity and of the degree of personality involvement. Andreasen and Bardach (1977) have proposed formal diagnostic criteria incorporating similar features: the dysmorphophobic symptom of excessive concern with appearance, the desire for surgery or underlying presence of personality disorder, and the absence of psychotic symptomatology. However, judgements of ‘neurotic’ versus ‘delusional’ intensity, of absence of psychotic symptomatology and of personality involvement may be particularly difficult against a background of developing personality and in adolescence the problem may be further compounded by the cumulative and recursive effects upon personality development of psychological disturbance.

Anorexia nervosa may sometimes be resistant to all forms of therapy, with cases running through a gamut of somatic and psychological treatments. One possible explanation for this may be that the illness is of heterogeneous aetiology (Kay and Leigh, 1938; King, 1963; Feighner et al, 1972), although others regard anorexia as a single condition that tends to breed true though having protean manifestations (Russell, 1970; Crisp et al, 1980). In most of the larger series of cases, a proportion have depressive symptoms both during the illness (Dally, 1969; Theander, 1970; Crisp et al, 1980) and some years later (Morgan and Russell, 1975; Hsu et al, 1979), and a family history of affective disorder is also commonly reported (Dally, 1969; Theander, 1970; Morgan and Russell, 1975). Cantwell et al (1977) have reviewed the complex relationship between depression and anorexia nervosa and have suggested that some of the remedies used in the treatment of depression merit further exploration in the management of anorexia nervosa. We report here a patient who was in hospital for over four years and in whose eventual improvement lithium may have played an important role.

The past 12 years have witnessed the establishment of behavioural methods of treating sexual problems based on the principles developed by Masters and Johnson (1970). Such methods, with some modifications, have proved to be well suited to the needs of our health service (Bancroft, 1975). It is an expedient time to take stock with regard to the current situation in this field, particularly the extent to which treatment facilities are meeting patients' needs, the type of methods being used, and how successful they are. In view of the rapid developments that have occurred in sex therapy it is also appropriate to consider what are now the oustanding clinical and research needs in this area.