The work histories of 75 completed suicides and 150 controls were compared to test Durkheim's theory of the protective nature of work. The suicides showed more unemployment, more absence through illness, had more frequent job changes and held their jobs for shorter periods. They were less likely to retire gradually. There was no difference in social class mobility. Suicides were more likely to come from high risk occupations. The comparatively poor work record of the suicides is attributed to their high level of psychiatric morbidity.

In 60 physically and mentally healthy human subjects, lumbar cerebrospinal fluid was analysed by mass fragmentography for 5-HIAA, HVA and MOPEG. Individuals with a family history of psychiatric morbidity had significantly greater variation in monoamine metabolite concentrations than subjects without such a family history. In subjects with a family history of schizophrenic psychosis 5-HIAA and HVA concentrations were significantly higher than in subjects with depressive disorders within the family. For subjects with deviant 5-HIAA levels the probability of having a psychiatric family history was 2.7 times higher than in subjects with normal values. For HVA and MOPEG similar relationships, but of a lower significance level, were found. The results suggest that the cerebral monoaminergic transmitter amines play critical roles in the pathophysiology of psychotic and depressive disorders with a family disposition. They also indicate a value of monoamine metabolite determination in CSF for the prediction of family vulnerability for psychiatric morbidity in healthy subjects.

Patients with anorexia nervosa show a decrease in psychoneurotic symptomatology as measured by the Crown-Crisp Experiential Index (CCEI) as their clinical status improves. Those who remain ill continue to display a moderate degree of varied psychopathology 4 to 8 years after their presentation. Vomiters and those with anxiety on eating with others can be distinguished on the CCEI from those without such features. Lower anxiety, phobia, obsessional and somatic scores at presentation are predictive of good outcome in terms of weight and menstrual function 4 to 8 years later.

Forty obsessive-compulsive ritualizers received nightly placebo or clomipramine up to 225 mgs nocte for 8 months, and received behavioural treatment (exposure in vivo) from weeks 4 to 10. Plasma concentrations of clomipramine and its primary metabolite N-desmethylclomipramine steadily increased over the first 4 weeks of treatment after which they remained relatively steady. Plasma levels correlated significantly with dose and with outcome but not with side effects. Patients with plasma clomipramine levels in the range 100–250 ng/ml and N-desmethylclomipramine levels between 230–550 ng/ml were found to improve significantly more than patients outside these ranges, thus suggesting a therapeutic window for clomipramine and its primary metabolite.

Clinical, psychometric and computed tomographic (CT) data are presented on three groups of elderly subjects: 50 normals, 40 patients with senile dementia and 41 suffering from affective disorder. Demented subjects showed significantly more CT evidence of cerebral atrophy than non-demented subjects, but there was considerable overlap. Although patients with a history or clinical signs of cerebral infarction were specifically excluded, such infarcts were found more often in CT scans of the dementia subjects than in the others, particularly when the diastolic blood pressure was raised. When correlating cognitive impairment with CT changes, ventricular size emerged as more important in the dementia patients, in contrast to the controls, in whom cortical atrophy was related to lower scores on a cognitive test. Other interesting findings included an inverse relationship between cortical atrophy and paranoid delusions.

Handedness was assessed in 272 schizophrenics and compared with findings in normal controls. The schizophrenics differed significantly from the normal controls in their handedness patterns, having a higher proportion of fully right-handed subjects. Findings in brain-damaged and elderly schizophrenic patients are also reported. The lack of consistency of reporting of handedness in schizophrenic populations in previous studies is discussed. While it is probable that differences in the methods of study of handedness account for some of the variance, differences in the type of schizophrenic illness seem likely to be of greater importance.

Six of eleven drug-free schizophrenic patients who were depressed following remission of their illness showed a significant decrease in their depressive symptomatology during a double-blind, placebo substitution lithium trial. Traditional indicators of prognosis did not predict lithium response in this small sample; the schizophrenic patients tolerated the lithium well. Lithium should be studied further in a larger patient sample as an adjunct in the treatment of post-psychotic depression, which frequently is treatment resistant.

Among 231 cases of manic-depressive illness parental loss before 17 years was high but was not associated with earlier onset of illness.

Psychological and somatic symptoms presented by women in middle life are frequently attributed to the menopause. Many writers have questioned this assumption and have placed more emphasis on environmental and personality factors. Using a life event model and a multivariate analysis technique, life stress was shown to have a significantly more powerful influence on the elevation of symptoms in a normal population of women at that age than did the menopause. Furthermore, the elevation in symptoms occurred some considerable time before that event. The finding that there was no significant increase in total life stress at that time of life suggests the presence of a vulnerability or moderating factor.

Five hundred and ten patients receiving long-term in-patient care for schizophrenia were examined in terms of their current mental state, cognitive functioning, neurological status and behavioural performance. The abnormalities of these areas of their present state were related to historical factors, personal details, the features of the illness at its worst and physical treatment received. Significant associations between the present state and historical factors were few and mainly concerned time and the features of the illness at its worst. Current abnormalities were not related to past physical treatment, but highly significant correlations were found between the impairments of the four areas of the present state. It is concluded that these impairments are likely to be an integral part of the disease.

Diagnostic and demographic data were collected from all 2,298 psychiatric hospital admissions for affective illnesses from private households in the City of Plymouth for the six-year period 1970–1975 inclusive. Intercorrelations of diagnostic subtypes were performed, together with a multiple regression analysis against spatial and ecological data from the 1971 Census. Rate differences were related to the geographic structure of Plymouth. With psychotic illnesses, ecological correlations were low for male and female first admissions and for male readmissions. However, important correlations relating to socio-economic status, housing tenure and structure, population instability, and other sociodemographic features emerged in varying degrees of specificity for reactive and neurotic illness in males, and for all readmissions in females, largely irrespective of diagnostic subtype. Explanations for the processes underlying these patterns are offered in terms of population structure, particularly the differing vulnerability of age and marital status groups, the referral and diagnostic process, social and physical stresses in the lower socioeconomic groups, and urban drift.

Clinical and computed tomographic (CT) data on a consecutive series of 41 elderly patients with affective disorders are presented, and comparisons made with a group of 50 healthy controls. In both groups ventricular size increased with age, but only in the controls was there an age correlation with sulcal widening. Using clinical and radiological criteria, the prevalence of cerebrovascular disease in the patient group was 12 per cent. A sub-group of patients with enlarged ventricles emerged, whose first depression began later in life, and who at the time of this study were older and showed more ‘endogenous’ features than the remainder. It is suggested that this provides further evidence that organic cerebral factors may have aetiological significance in some depressions of old age.

A standardized study of the point prevalence of non-psychotic disorder was carried out on a systematic sample of Canberra residents (N = 756). Rates were estimated for PSE CATEGO diagnoses and the Index of Definition. The association between neurosis and deficiencies in social relationships was examined, using the Interview Schedule for Social Interaction (ISSI). An objective measure of exposure to adversity was also obtained at interview. Both attachment and social integration (affectionally close and more diffuse relationships) were found to be negatively associated with neurosis. This association holds in its own right, in addition to an interaction with the load of adversity. The associations are weaker for men.

The significance of this work lies in its demonstration of an association between neurosis and the lack of social ties, and in its attempt to obtain a specification of those elements in social relationships which, when deficient, may be associated with neurosis. The direction of causality has now to be investigated.

One hundred consecutive referrals to a general medical out-patient clinic were evaluated psychiatrically under blind conditions in order to investigate the nature and occurrence of non-organic disease presenting as gastrointestinal illness. Twenty-eight patients had marked psychiatric illness with or without physical illness, and there was an association between psychiatric illness and the absence of organic disease, as determined by outcome at follow-up of 4–11 months. Patients with obsessional traits were more at risk of non-organic illness. Historical items indicating a likelihood of non-organic gastrointestinal illness included ‘nerves', ‘depression’, unhappy childhood, early parental loss and early separations from parents during childhood. Psychiatric illness often persisted after treatment for physical symptoms. Some of the techniques used in this study to identify psychiatric illness could be usefully employed in everyday practice.

Erythrocyte and leucocyte numbers and cyclic AMP content were monitored weekly in a mentally defective short-cycle manic-depressive woman. The erythrocyte count remained relatively constant but cyclic AMP content when manic was significantly higher than when depressed, and the mood and biochemical data appeared to have the same periodicity, with coincident peaks and troughs. Total leucocytes were related to mood, with peaks in the manic phase. Mononuclear cyclic AMP content varied without relation to manic or depressive phases.

The effects of hypothyroidism are protean, involving many systems. Electrocardiographic changes are almost invariable, and include bradycardia, low QRS voltage and flattened T waves: these are usually reversible with replacement therapy (McDonald, 1978). Psychiatric disturbances are also well known, although they are seldom the presenting feature and are notorious for mistakes in diagnosis (Lishman, 1978; Whybrow and Ferrell, 1974). Most such disturbances comprise apathy and depression, some an organic reaction and a few manifest as an acute schizophrenia-like psychosis. Phenothiazines, the most generally used neuroleptic medication, may interfere with cardiac conduction. When hypothyroidism presents as acute psychosis and the patient is hypersensitive to phenothiazines a dangerous situation can arise.

The duration of standardised overbreathing required to produce slow wave activity in the EEG during different phases of the menstrual cycle has been studied, and changes in carbon dioxide sensitivity of the respiratory system. Normal subjects developed slow waves more quickly and had more sensitive CO2 responses during the premenstrual/menstrual phases. This may be a factor contributing to premenstrual tension.

The social, criminal and psychiatric backgrounds of 878 male patients admitted for the first time to the three English Special Hospitals during the years 1961–1965 are examined and the implications of differences between them for research discussed. It is noted that only 35 per cent of the admission group have been discharged within a four year period. The need for long term follow-up studies is stressed.

One hundred consecutive referrals have been surveyed, the diagnostic and behavioural problems leading to referral considered and follow-up information obtained one year later. For most admission to hospital as in- or day-patients was unnecessary. Old people's homes do not make excessive demands on the psychiatric services, but deserve support, including help in developing a more tolerant and flexible approach to less conforming residents. This is becoming imperative now that old people's homes are dealing with increased numbers of disturbed residents.

Twenty patients with the diagnosis hysterical personality disorder were compared with a matched control group of patients with other personality and neurotic diagnoses. Subjects' moods were assessed with a visual analogue scale 4 times a day for 5 consecutive days. Patients with a primary discharge diagnosis of hysterical personality disorder showed greater variability of mood than controls. Since emotional lability is said to be a characteristic hysterical trait, the results are taken as empirical support for the validity of one of the clinical judgements inherent in the diagnostic process.