The UCLS questionnaire, in a form modified to include a measure of syllabus-boundness, and a questionnaire to measure psychiatric symptomatology (the MHQ) were administered to two groups of students, one seeking help for emotional problems, the other a control group. Groups were compared on tests, test findings were inter-correlated, and scores were related to academic success. The UCLSQ is confirmed as a reliable research instrument. Principal component analysis again indicates a separation of psychoneurotic and motivational components of study difficulty. Syllabus-boundness (‘Sylbism’) emerges as a relatively independent trait, with a significant negative relationship to work satisfaction in both groups. MHQ, scores again show a positive correlation between phobic anxiety and academic attainment for patients.

Serial studies of urinary cyclic AMP in in-patients undergoing electroconvulsive therapy (ECT) have been carried out. No consistent pattern of change following ECT could be demonstrated. The results do not support earlier reports of large rises in urinary cAMP directly after administration of ECT.

This paper reports on the clinical status, help-seeking and subsequent treatment experiences of 150 women one year after they had completed out-patient maintenance treatment by amitriptyline and/or psychotherapy for a depressive episode.

While the majority of patients were asymptomatic at follow-up, a substantial minority had a return of acute symptoms and 2 per cent made minor suicide attempts during the year. Admission to hospital was rare. However, only 30 per cent of the patients did not seek any treatment during the year and the majority received some psychotropic medication.

The findings support the long-term need for prompt access to treatment by patients who have recovered from an acute depression.

This paper is concerned with the further evaluation of the Clifton Assessment Schedule (CAS), a brief psychogeriatric assessment procedure, providing a cross-validation study on a second sample of acute elderly psychiatric admissions. Additionally, further work is reported on its use with a psychogeriatric population resident within the hospital. The results suggest the usefulness of the CAS across a broad range of psychogeriatric patients, providing significant differentiation between groups receiving varying degrees of care and with differing outcome expectations.

The breathing rate and PCO2 in end-tidal air have been studied in controls and in patients with endogenous depression (retarded and non-retarded), with neurotic depression, and with schizophrenia. It has been shown that breathing rate goes up and PCO2 down in non-retarded and neurotic depression. Schizophrenia gives more anomalous results. The fact is emphasized that such changes must lead to alterations in pH and other variables. Studies showing some small chemical differences between these clinical entities and control subjects might therefore be explained by these findings.

This paper reports the results of measures taken during treatment in the study of imaginai flooding and exposure to real phobic situations previously described by Mathews, Johnston, Lancashire, Munby, Shaw and Gelder (1976). On weekly measures of change a similar reduction in phobic behaviour in all treatments was found, confirming the previous findings. Differences in therapist effectiveness were also confirmed. On measures of the immediate effects of treatment, exposure to the phobic situation had consistent positive effects, imaginai flooding had little or no detectable effect. It is proposed that the treatments studied differ in their immediate effects on phobic behaviour but also have the common effect of facilitating counterphobic behaviour outside the treatment situation, and that this is the main agent of therapeutic change.

Ratings on 39 symptoms were examined for patients admitted to the Neuropsychiatric Institute of the University of Michigan Medical Center. A detailed evaluation was made of the clusters derived by a hierarchical clustering algorithm, using complete linkage and a simple matching coefficient on the binary variables of presence or absence of symptoms. The four groups of patients suggested by the cluster analysis can be characterized as follows: (1) generalized multiplicity of symptoms; (2) capacity to cope except for orientation apart from generally held norms; (3) activity level and thought processes speeded up, intensified, and unselected; (4) inwardly punitive, slowed down and distressed. It is shown that these groups received significantly different treatment and that the effect of treatment was significantly different, while no such differences were noted for groups defined in terms of diagnoses. By means of linear discriminant functions, rules are suggested for assigning other psychiatric patients to one of these four groups.

A retrospective, multi-source screening study has detected 148 users (110 males, 38 females) of intravenous drugs who presented to all relevant agencies between 1971 and 1973 in Bristol, a city where maintenance therapy is a very infrequent practice. The peak prevalence was found in the age group 20–24 years, and it appeared that the chief sources of drugs were burglaries of chemists' shops and general practitioner prescriptions. Sixty-four per cent of our users had not been notified to the Home Office. Suggestions are made for the future monitoring and development of services.

The outcome of a standard four-day intensive symptomatic treatment programme with 39 agoraphobics is examined in relation to the incidence of fresh symptom emergence. Twenty-six patients suffered fresh symptom emergence during follow-up, and there was a significant association of fresh symptom emergence with poorer outcome at one-year follow-up. About 18 per cent of patients were adversely affected by the treatment programme, as judged on a wide range of symptoms and measures of inter- and intra-personal adjustment. Sixteen individually treated patients are then compared with the 39 group-treated patients and differences in drop-out rate are discussed.

In a day hospital all staff members must be able to make rapid decisions, even when they cannot refer to their seniors. It is difficult to develop this capability in a teaching day hospital where the staff and student groups are constantly changing. It has, however, been facilitated by regular staff discussions with a visiting psychotherapist. In these staff groups, the study of role attributions and dynamics characteristic of families has diminished the interference caused by ‘family’ type dynamics in daily professional interaction. The paper describes the effect of such discussion in stimulating the adoption of a treatment approach which takes the family situation into account. This family approach is distinguished from family therapy, and its advantages are discussed.

The author studied the significance of ethnic origin and immigrant status in attempted suicide. Epidemiological data (1969–72) indicated that self-poisoning among West Indian immigrants in Birmingham was less prevalent than among natives there but more prevalent than in the West Indies. The association of recent pregnancy with attempted suicide among young immigrant patients was noteworthy.

Attempted suicide among immigrants was often relatively benign; few abused alcohol or drugs or made repeated attempts. The markedly lower male rate of attempted suicide, and its rarity in older persons, confirms previous findings.

Thirty-six children between the ages of 2 and 17 bereaved by the suicide of a parent were followed up after 5 to 7 years. The children's home life before bereavement had been abnormal because of mental illness, and family disruption and pre-suicide stresses were significantly related to present functioning. An incidence of psychological morbidity greater than that of a comparison group was observed. Some children appear to cope with the experience of parental suicide without serious consequences; for a few there was relief from an insupportable situation.

Tradition retains the practice of attaching mental nurses to wards rather than to groups of patients, even though the wards are increasingly empty as patients come to lead more active lives in hospital. A system is described which enables nurses to relate more fully to the people in their care instead of having to confine their activities to the place in which only a part of the care is provided. This system involves all ward nurses in leaving their wards empty in ‘working hours', being relieved of the care of their intercurrently ill patients and undertaking in exchange the complete day care of their fitter patients in both wards and workplaces. The consequences of these changes are attractive to many nurses and helpful to many patients.

The paper reports an extension of work into the relevance of personality and pre-treatment expectancies for allocation and response of patients to group psychotherapy. The results show that subjects who are internally directed in interest and who have a liberal attitude to a variety of social issues and a ‘psychological’ set to treatment are more responsive to group psychotherapy as seen by their therapists as well as by themselves. Those who are externally directed in interest and who have a conservative attitude to life and a more ‘medical-physical’ set to treatment are more likely to be referred for behaviour therapy; if referred for group psychotherapy they are likely either to drop out or to show very limited response to treatment.

This study examined the hypothesis that there are seasonal variations for suicide, hospital admissions for depressive illnesses and electroconvulsive therapy and that these are inter-related. It was found that the seasonal variations did coincide, with peaks occurring in the Ontario spring and autumn. The importance of depression as a cause of suicide and the effect of electroconvulsive therapy upon the suicide rate are discussed.

In an effort to examine the placebo, psychological deterrent, and pharmacological deterrent effects associated with implanted disulfiram, subjects were given either disulfiram implants or sham operations. Ethanol challenges elicited no disulfiram-ethanol reactions (DERs), indicating that at the time of the challenge neither a pharmacological deterrent nor a placebo effect was operating. Of the patients who resumed drinking, only those with disulfiram implants experienced DERs. Sham operation subjects continued to drink after their first post-challenge drink; four of five disulfiram implant recidivists remained abstinent following their experience of a DER. It is concluded that the pharmacological deterrent effect of the disulfiram implant may have been underestimated in previous reports.

122 Schizophrenic patients treated with injections of fluphenazine ethanate, 97 with fluphenazine decanoate and 199 with flupenthixol decanoate were followed up for mean times of 41, 33 and 21 months respectively. Their progress was compared by examining reasons for discontinuing injections and outcome in three separate groups defined according to first preparation given; relating the events causing patients to discontinue injections or be readmitted to patient-months spent on each drug; and analysing reasons for inter-drug transfers 43 per cent, 24 per cent and 23 per cent respectively of these three groups of patients discontinued the injections. Severe extrapyramidal effects were most frequent with fluphenazine ethanate, intermediate with fluphenazine decanote, and least frequent with flupenthixol. Lack of cooperation was rather more frequent with flupenthixol than with the other drugs. Severe depression occurred with all three. More patients on fluphenazine injections were transferred for any reason to flupenthixol than vice-versa. A case of ‘irreversible’ movement disorder was seen with each preparation. It is suggested that current maintenance doses of flupenthixol decanoate are too low.