The management of sexual delinquents, especially those with compulsive putting into action of aggressive sexual impulses, poses great problems for the medical profession from the therapeutic as well as the moral standpoint. In the past thirty years or so numerous different approaches have been tried with varying degrees of success. A much abridged list of more recent treatment procedures includes: surgical castration (Stürup, 1968), sedative and/or tranquillizer drugs (Litkey and Feniczy, 1967; Bartholomew, 1968), female sex hormones (Allen, 1970); psychological measures such as psychotherapy (Ellis, 1956; Mayerson and Lief, 1965; Allen, 1970) and/or behaviour (‘aversion’) therapy (MacCulloch and Feldman, 1967) and ‘right up-to-date’ hypothalamotomy (B.M. J., 1969). Unfortunately surgery, which is the most reliably effective of these treatments, may have unpleasant sequelae; its use, which (in Britain at least) is beset with ethical problems, is therefore justified in only the most recalcitrant and/or dangerous types of offender, and only then when other methods have failed.

Dermatoglyphic patterns, especially fingerprints, have long been of interest to researchers in the genetics of schizophrenia, but results of investigations have been inconsistent. Rosner and Steinberg (4) published the first dermatoglyphic study of Negro male schizophrenics, comparing finger and palm prints of 207 patients at Virginia State Hospital with those of 105 healthy Negro males from the National Institute of Neurological Diseases and Blindness Perinatal Study. This is the second report on the dermatoglyphics of Negro male schizophrenics.

Amitriptyline is a widely used antidepressant and its effectiveness has been shown, e.g. in comparison with imipramine in double blind trial (Burt et al., 1962; Hordern et al., 1963, 1964). A disadvantage of currently prescribed tricyclic antidepressants is the necessity for administering the drug three times a day. It has been shown that general medical and in particular psychiatric patients fail to take their medication either in the prescribed dose or at all (Benstead and Theobald, 1952; Haler, 1952; Park and Lipman, 1964; Parkes et al., 1962; Porter, 1969). This failure rate may be as high as 50 per cent (Dixon et al., 1957; Willcox et al., 1965). Even in psychiatric in-patient studies there was still a high failure rate in taking prescribed psychiatric drugs (Hare and Willcox, 1967). A regimen consisting of a single daily dose is more reliably taken than one consisting of thrice daily dosage (Coppen et al., 1969; General Practitioner Clinical Trial 1970).

Paternal incest has been known and recorded in all periods of history and in all types of civilization. It seems to be a universal phenomenon which does not recognize any historical, geographical, racial or social boundaries: it was practised by royal families in classical Egypt, Greece, Peru and Japan; it occurred among some ruling families in mediaeval Europe; nowadays it has been reported in most industrial countries of Europe and America, as well as in the remote islands of Polynesia. Incest seems to exist everywhere, in spite of the fact that it is regarded as taboo in many primitive societies (Cooper, 1932; Freud, 1919; Walker, 1940), and is condemned in all Western societies, both by the Church, which regards it as a serious 'sin’ and by the Law, which makes it an indictable offence.

Retardation, i.e. abnormal slowness in performing mental and/or motor tasks, is frequently noted as being a prominent feature of schizophrenia. While some writers describe it as being merely one of the several clinical signs and symptoms of schizophrenia, others suggest that retardation has a causative role, and is a basic disorder underlying antisociability and withdrawal from reality (Babcock, 1933), intellectual deficit (Shapiro and Nelson, 1955), affective flattening (Harris and Metcalfe, 1956), thought-process disorder (e.g. Yates, 1966), and other disorders.

In 1963 Coppen and Shaw reported that patients with manic-depressive psychosis showed, on clinical recovery, a significant decrease in exchangeable sodium, and in residual sodium (exchangeable minus extracellular sodium), presumed intracellular, per litre of body water. Coppen, Shaw, Malleson and Costain (1966) found a similar type of shift in mania but the deviation from normal was, on average, more extreme. Although low and high sodium diets had no effects on the distribution of sodium in manic-depressive psychotics, the administration of spironolactone resulted in a significant reduction of residual sodium (Coppen, 1970). The possible involvement of aldosterone in these changes led Jenner et al. (1967) to examine aldosterone excretion in a 48-hour cycle patient and Murphy, Goodwin and Bunney (1969) to examine groups of manic and depressed patients. Murphy et al. found lower rates of excretion of aldosterone in depression than in mania, but Jenner et al. found the opposite.

A sedative or tranquillizing effect may be important in the treatment of mild depressive illness not requiring admission to hospital or ECT (Wheatley, 1969), and Hare et al. (1962, 1964) have suggested that antidepressant drugs may exert their effect by virtue of their sedative action. Other workers also have found similar effects from antidepressant drugs and tranquillizers (Overall et al., 1964; Paykel, 1969).

A survey has already been presented (British Journal of Psychiatry, November 1971) of all patients seen by the senior psychiatric staff of Leverndale Hospital and the Victoria Infirmary, Glasgow, with a view to termination of pregnancy for the period of two years following the implementation of the Abortion Act, i.e. from April 1968 to April 1970. During this time 116 patients were seen, of whom 71·5 per cent were recommended for termination. Follow-up of cases not so recommended showed that one-third obtained abortion elsewhere; the rest apparently made a reasonable adjustment to their situation.

Recently several communications have been published implicating impaired 3′5′ cyclic adenosine monophosphate (cyclic AMP) metabolism as a causal factor in affective disorders (1, 3, 7, 8, 9, 11). In particular, the urinary excretion of cyclic AMP in manic patients is reported to be increased compared with that of normal subjects, whereas in depressed patients a decreased excretion has been observed (1, 7, 8, 9). These findings form the basis of a theory explaining the systemic and mental symptoms of affective disorders (1).

In order to try to overcome the common clinical experience of patients who do not take the drugs prescribed for them (Wilcox et al., 1965) a sustained release form of amitriptyline (Lentizol) has recently been made available. This trial was undertaken to test the efficacy of this formulation given once daily at night compared to standard amitriptyline given thrice daily.

The last decade has seen a shift in the emphasis of research into student problems and student performance. On the psychological side there has been a move away from somewhat static concepts of personality measurement and intellectual assessment, and the concomitant preoccupation with prediction and selection, towards a more interactive approach in which individual aspects are related to academic and social processes (e.g. Sanford, 1962; Lavin, 1965; Wankowski, 1969). On the mental health side there has been a shift from 'syndrome identification’ towards a more dynamic appraisal of personal and social forces and their interaction (Grant, 1969; Ryle, 1969; Lucas and Linken, (1970).

Psychiatric Social Work as a profession with its tradition, training and culture rooted in the Hospital Service, will in all probability soon cease to exist. It would appear that the imminent decease of this profession is not generally known or understood. This account, an expression of much personal regret, is also an attempt to give a background to the current situation. It pays tribute to the medical profession, without whom the Psychiatric Social Workers would never have acquired their specialization and expertise. It has been in hospitals and other allied settings that the Psychiatric Social Workers have practised their professional skills and had the opportunities to keep abreast of clinical progress and new approaches to mental health, so essential to teaching new generations.

The patient, C, was a 33-year-old woman who attended hospital complaining of depression, inability to sleep, and weakness of hands and legs. This had been going on for 4 to 5 weeks. She had been suffering from ‘writer's cramp’ five years previously but this had been satisfactorily treated with drugs.

Among patients admitted to psychiatric hospitals are some who are discharged undiagnosed. It can be expected that psychiatric patients, as patients in other medical specialties, who do not meet the criteria for any of the established diagnostic groups, will be considered as undiagnosed until the course of their illness and clinical picture makes the diagnosis evident. The undiagnosed patients are a diagnostic and therapeutic challenge. Because in a space of five years, 256 patients left undiagnosed, it was felt that this group merited investigation.

The constructs (Kelly, 1955) which individuals use when describing other people may be classified as ‘psychological’, i.e. those referring to the personality and emotional state of the people, or as ‘objective’, i.e. those referring to their physical characteristics, social class, clothing etc.

The renewed use of modified forms of narcosis, generally given together with ECT and antidepressant drugs, arose from a series of observations made during attempts to treat a group of chronically tense patients. These patients, the majority of whom had been diagnosed as ‘chronic tension states', had been referred to the Department of Psychological Medicine at St. Thomas' Hospital for assessment regarding their suitability for modified leucotomy. Birley (1964), in a follow-up study of previous patients with ‘tension states' treated by leucotomy at St. Thomas' Hospital, had found that many developed clear-cut attacks of depression following the operation. This suggested to one of us (W.S.) that such ‘tension states' might have been masked depressive illnesses, in whom the underlying diagnosis had been missed. Consequently it was decided that in the future such patients should be treated with suitably long courses of ECT, together with one or both groups of antidepressant drugs, before any question of recommending leucotomy arose. As a result, a considerable number of these patients were greatly improved and no longer required a leucotomy. Others, however, became more tense and distressed during treatment with ECT and drugs; modified narcosis, therefore, was given in addition, to allow the full course of ECT to be completed. It was then that another of us (C.W.) observed that patients who were treated with combined narcosis, ECT and antidepressants appeared to respond more favourably, and were much less upset by the treatment, than those receiving ECT and antidepressants alone. In a preliminary report published in 1966, Sargant, Walter and Wright described a group of 73 patients with ‘chronic tension states', of whom 67 per cent had improved markedly with further treatment of their underlying depression. It was noted that 15 of the 37 patients treated with ECT and antidepressants alone still required a leucotomy, while in the group treated with modified narcosis in addition to ECT and antidepressants the operation was needed in only 3 of the 36 patients. It appeared, therefore, that the addition of narcosis to drugs and ECT greatly improved the recovery rate.

Early studies (21, 22, 25, 12) have pointed to a genetic component in the aetiology of manic-depressive disorders. More recently, careful clinical observation has suggested the division of the affective disorders into two distinct groups: the so-called bipolar or manic-depressive group and the unipolar type with recurrent depressions only (14, 27, 1). Although genetic differences in terms of family risk have been demonstrated between the so-called bipolar and unipolar psychoses, it is not yet evident whether each group constitutes a homogeneous entity. Moreover, the diagnosis of unipolar depressive disease for the authors cited above includes such syndromes as involutional psychotic reactions, psychotic depressive reactions, and probably also psychoneurotic depressions.

In 1968, the Veterans Administration and the National Institute of Mental Health organized a multi-hospital collaborative study on the effectiveness of lithium carbonate in acute mania. Two hundred and fifty five newly-admitted patients with this disorder were randomly assigned to lithium or chlorpromazine treatment for a three-week period. Patients were classified as highly active or mildly active on the basis of hyperactivity shown at admission. Results have been reported in a previous paper (7). Briefly, it was found that chlorpromazine was significantly superior to lithium in treating the highly active patient: chlorpromazine acted more quickly than lithium, produced significantly fewer treatment failures, and had a lower incidence of severe side effects. The difference between treatments was less clear-cut with mildly active patients, although lithium appeared to be the better treatment. Both drugs effectively reduced manic symptomatology, but lithium produced fewer severe side effects and left the patient less sluggish and fatigued. The poor results with lithium among highly active patients were attributed to the drug's relatively slow onset of action. As a group, highly active patients on lithium showed relatively little change in manic behaviour during the first week; it was ten days before some patients showed any improvement. Almost 40 per cent of the highly active patients had to be taken off lithium before the end of three weeks because of unmanageable behaviour or toxicity. In contrast, chlorpromazine, with its quick onset of action, generally controlled manic symptoms

This study compares the mental symptoms of two groups of aged mental hospital patients. One group had senile brain disease but no brain infarcts. The other group had brain infarcts but no positive evidence of senile brain disease.